Basic Information
Provider Information | |||||||||
NPI: | 1891834883 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 720 COOL SPRINGS BLVD | ||||||||
Address2: | SUITE 300 | ||||||||
City: | FRANKLIN | ||||||||
State: | TN | ||||||||
PostalCode: | 370672626 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6157784066 | ||||||||
FaxNumber: | 6157789114 | ||||||||
Practice Location | |||||||||
Address1: | 2080 SPRINGER DR | ||||||||
Address2: |   | ||||||||
City: | LOMBARD | ||||||||
State: | IL | ||||||||
PostalCode: | 601486402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6309324540 | ||||||||
FaxNumber: | 6309324745 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2007 | ||||||||
LastUpdateDate: | 09/13/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | YALDO | ||||||||
AuthorizedOfficialFirstName: | RAAD | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9723648000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.