Basic Information
| Provider Information | |||||||||
| NPI: | 1750870945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR ACCESS CENTERS OF ILLINOIS AT NORTH CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 S DES PLAINES ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606615500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126542721 | ||||||||
| FaxNumber: | 8669545804 | ||||||||
| Practice Location | |||||||||
| Address1: | 2608 W ADDISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606185905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737563333 | ||||||||
| FaxNumber: | 7735491717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | FLYNN | ||||||||
| AuthorizedOfficialFirstName: | P. | ||||||||
| AuthorizedOfficialMiddleName: | KEVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO/VICE PRES FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3126542711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.