THE MEDADDRESS S.C. NPI 1205075942

NPI Information

  • NPI: 1205075942
  • Provider Name: THE MEDADDRESS, S.C.
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Address: 303 E PARK AVE
    SUITE 103
    LIBERTYVILLE, IL
    ZIP 60048
  • Phone: (847) 522-7505

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NPI Details

THE MEDADDRESS, S.C. is a primary care clinic center in Libertyville, IL. THE MEDADDRESS, S.C. NPI is 1205075942. The provider is registered as an organization entity type.

The provider's business location address is:

303 E PARK AVE
SUITE 103
LIBERTYVILLE, IL
ZIP 60048-872
Phone: (847) 522-7505

The provider's authorized official is Nina S Maniquis .
The authorized official title is President and has the following contact phone number (847) 522-7505.

The enumeration date for this NPI number is 2/18/2009 and was last updated on 11/2/2011.

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
1261QP2300XClinic/CenterPrimary CareYes

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
1042619466MEDICAIDILLINOIS

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: 11/21/2025

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