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NPI Code Detail

MEDICARE: NORTHERN ILLINOIS CANCER TREATMENT CENTER

MEDICARE: NORTHERN ILLINOIS CANCER TREATMENT CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105215222OTHERILBLUE SHIELD PROVIDER NUMB

General Provider Information

NPI Number : 1386644995
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN ILLINOIS CANCER TREATMENT CENTER
Provider Business Mailing Address
First Line : 327 IL ROUTE 2
Second Line :
City : DIXON
State : IL
Zip : 61021-9118
Country : US
Telephone Number : 815-284-1111
Fax Number : 815-284-2306
Provider Business Practice Location Address
First Line : 327 IL ROUTE 2
Second Line :
City : DIXON
State : IL
Zip : 61021-9118
Country : US
Telephone Number : 815-284-1111
Fax Number : 815-284-2306
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : JON BERENS
Credential :
Telephone Number : 815-284-1111
Provider Enumeration Date : 07/26/2005
Last Update Date : 01/02/2024

Similar Medicare Providers

1922114115 — SINNISSIPPI CENTERS, INC.
Practice Location Address:
325 IL ROUTE 2
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61021-9118
Practice Phone: 815-284-6611
Practice Fax: 815-284-2834
1518073139 — MRS. MARY ANN SCUFFHAM RNC
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325 IL ROUTE 2
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1992814792 — MR. THOMAS JAMES HERMES LCSW
Practice Location Address:
325 IL ROUTE 2
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Practice Fax: 815-284-2834
1578664868 — SINNISSIPPI CENTERS, INC.
Practice Location Address:
325 IL ROUTE 2
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61021-9118
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Practice Fax: 815-284-6641
1932299138 — MS. ALISA WOLF LCSW
Practice Location Address:
325 IL ROUTE 2
DIXON, IL
61021-9118
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Practice Fax: 815-284-6598
1871677039 — SINNISSIPPI CENTERS INC.
Practice Location Address:
325 IL ROUTE 2
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61021-9118
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Practice Fax:

Directions to “NORTHERN ILLINOIS CANCER TREATMENT CENTER ” Practice Location

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