1982035986 NPI number — CADENCE HEALTH

Table of content: PETER JAMES JACOBY MD (NPI 1457377228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982035986 NPI number — CADENCE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CADENCE HEALTH
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:
1982035986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 N. WINFIELD RD
Provider Second Line Business Mailing Address:
WOMEN'S AND CHILDREN'S
Provider Business Mailing Address City Name:
WINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-933-6091
Provider Business Mailing Address Fax Number:
630-933-2995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 N. WINFIELD RD
Provider Second Line Business Practice Location Address:
WOMEN'S AND CHILDREN'S
Provider Business Practice Location Address City Name:
WINFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-933-6091
Provider Business Practice Location Address Fax Number:
630-933-2995
Provider Enumeration Date:
12/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BELMONTE
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
630-933-6091

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  246000158 , 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)