=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972773042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS HEALTH CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2008
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 S RIVER RD SUITE 7
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-294-9614
-----------------------------------------------------
Fax | 847-294-9644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 S RIVER RD SUITE 7
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-294-9614
-----------------------------------------------------
Fax | 847-294-9644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, CEO
-----------------------------------------------------
Name | DR. RENLIN XIA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-216-1460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 7003184
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------