MEDICARE: LAKE BARRINGTON WOMENS HEALTH CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL2981	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04900984	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1558332940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE BARRINGTON WOMENS HEALTH CENTER PC

Provider Business Mailing Address
First Line	:	22N285 PEPPER RD
Second Line	:	SUITE 111
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2539
Country	:	US
Telephone Number	:	847-382-7330
Fax Number	:	847-382-9654

Provider Business Practice Location Address
First Line	:	22N285 PEPPER RD
Second Line	:	SUITE 111
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-5982
Country	:	US
Telephone Number	:	847-382-7330
Fax Number	:	847-382-9654

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. THOMAS J MEYER
Credential	:	M.D.
Telephone Number	:	847-382-7330

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/21/2022

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