1811412729 NPI number — CORNUCOPIA STAFFING SOLUTIONS CORP

Table of content: DR. VICKI M. SANDS M.D. (NPI 1043395080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811412729 NPI number — CORNUCOPIA STAFFING SOLUTIONS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNUCOPIA STAFFING SOLUTIONS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811412729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ILLINOIS ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60174-1867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 EXECUTIVE DR.
Provider Second Line Business Practice Location Address:
ST 305-307
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-375-3937
Provider Business Practice Location Address Fax Number:
312-488-3637
Provider Enumeration Date:
08/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KEYES
Authorized Official First Name:
CORPIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
866-375-3937

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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