1841395092 NPI number — VALLEY EMERGENCY CARE MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841395092 NPI number — VALLEY EMERGENCY CARE MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY EMERGENCY CARE MANAGEMENT, INC.
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:
1841395092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/01/2024
NPI Reactivation Date:
11/08/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-9030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-495-1624
Provider Business Mailing Address Fax Number:
847-537-4866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 RANDALL RD
Provider Second Line Business Practice Location Address:
EMERGENCY DEPT
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60134-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-208-4009
Provider Business Practice Location Address Fax Number:
630-208-0942
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
PARKSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-667-9587

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , 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: 0451530938 . This is a "BLUE SHIELD GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CC0707 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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