Basic Information
| Provider Information | |||||||||
| NPI: | 1104064260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINAC MEDICAL CENTER SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2032 W CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606084116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732478855 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2032 W CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606084116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732478855 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | CARDENAS | ||||||||
| AuthorizedOfficialFirstName: | VICENTE | ||||||||
| AuthorizedOfficialMiddleName: | EUGENIO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7732478855 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036103295 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.