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MATHERS CLINIC LLC NPI 1215194519


NPI Information

NPI: 1215194519
Provider Name: MATHERS CLINIC, LLC
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Organization

Specialization: Child & Adolescent Psychiatry

CLIA Number: 14D2000820

Address:
5804 ELAINE DR
ROCKFORD, IL
ZIP 61108
Phone: (815) 397-7654
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MATHERS CLINIC, LLC is a child and adolescent psychiatry psychiatry neurology in Rockford, IL. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. MATHERS CLINIC, LLC NPI is 1215194519. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5804 ELAINE DR
ROCKFORD, IL
ZIP 61108-435
Phone: (815) 397-7654
Fax: (815) 397-2712

The provider's authorized official is Ramesh Babu Vemuri .
The authorized official title is Vice President and has the following contact phone number (815) 397-7654.

The CLIA number assigned to this NPI record is 14D2000820 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2008 and was last updated on 5/22/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry36039266ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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