Healthcare Provider Details

I. General information

NPI: 1356709489
Provider Name (Legal Business Name): SMARTCAREHUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 22ND ST
OAK BROOK IL
60523-2074
US

IV. Provider business mailing address

1415 W 22ND ST
OAK BROOK IL
60523-2074
US

V. Phone/Fax

Practice location:
  • Phone: 312-806-3800
  • Fax: 630-684-2299
Mailing address:
  • Phone: 312-806-3800
  • Fax: 630-684-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GERALD THOMAS GALLOWAY
Title or Position: PRINCIPAL
Credential:
Phone: 630-684-2303