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MID AMERICA MEDICAL CENTER LTD NPI 1407117468


NPI Information

NPI: 1407117468
Provider Name: MID AMERICA MEDICAL CENTER, LTD
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
639 W NORTH AVE
VILLA PARK, IL
ZIP 60181
Phone: (630) 516-0960
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MID AMERICA MEDICAL CENTER, LTD is a clinic center in Villa Park, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). MID AMERICA MEDICAL CENTER, LTD NPI is 1407117468. The provider is registered as an organization entity type.

The provider's business location address is:

639 W NORTH AVE
VILLA PARK, IL
ZIP 60181-321
Phone: (630) 516-0960
Fax: (630) 516-0951

The provider's authorized official is Ibrahim Sadek .
The authorized official title is Medical Director/owner and has the following contact phone number (630) 516-0960.

The enumeration date for this NPI number is 6/6/2012 and was last updated on 6/13/2012.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/Center036-083248ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1F22765MEDICARE UPIN

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: 5/5/2024

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