=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891095139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALTY CARE INSTITUTE, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2010
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1750 N RANDALL RD STE 210
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60123-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-888-9000
-----------------------------------------------------
Fax | 847-888-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1750 N RANDALL RD STE 210
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60123-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-888-9000
-----------------------------------------------------
Fax | 847-888-9001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | ANNETTE M MARTYN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-888-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 036087745
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------