Healthcare Provider Details

I. General information

NPI: 1801858741
Provider Name (Legal Business Name): JAMES A LOVELL FHCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 SAMPSON STREET BLDG 237
GREAT LAKES IL
60088
US

IV. Provider business mailing address

PO BOX 322
NORTH CHICAGO IL
60064-0322
US

V. Phone/Fax

Practice location:
  • Phone: 224-610-4232
  • Fax: 224-610-3712
Mailing address:
  • Phone: 224-610-4232
  • Fax: 224-610-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT G BUCKLEY
Title or Position: CAPTAIN
Credential: MD, MPH, FACEP
Phone: 224-610-3735