1841217767 NPI number — STRAUSS SURGICAL GROUP ASSOC, S.C.

Table of content: (NPI 1841217767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841217767 NPI number — STRAUSS SURGICAL GROUP ASSOC, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRAUSS SURGICAL GROUP ASSOC, S.C.
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:
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:
1841217767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 W 79TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60459-1784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-884-4523
Provider Business Mailing Address Fax Number:
773-884-4580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4640 N MARINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-564-6200
Provider Business Practice Location Address Fax Number:
773-564-6201
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOHN
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-564-6200

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  036036482 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01615141 . This is a "BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036036482 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340007445 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com