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1912063439 NPI number — COOK COUNTY

NPI Number: 1912063439
Health Care Provider/Practitioner: COOK COUNTY

Information about “1912063439” NPI (COOK COUNTY) exists in 1912063439 in HTML format HTML  |  1912063439 in plain Text format TXT  |  1912063439 in PDF (Portable Document Format) PDF  |  1912063439 in an XML format XML  formats.

NPI Number : 1912063439 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912063439",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "COOK COUNTY",
    "ParentOrgTIN": null,
    "OrgName": "COOK COUNTY",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "15900 SOUTH CICERO AVENUE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAK FOREST",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60452-4000",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "708-633-3400",
    "MailingAddressFaxNumber": "708-633-3407",
    "FirstLinePracticeLocationAddress": "605 S WOLCOTT AVE, SUITE 605",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60612",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-864-4649",
    "PracticeLocationAddressFaxNumber": "312-864-9763",
    "EnumerationDate": "12/29/2006",
    "LastUpdateDate": "12/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDRLE",
    "AuthorizedOfficialFirstName": "SCOTT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR OF MANAGED CARE OPERATIONS",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "312-864-4649",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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