Provider Demographics
NPI:1013183706
Name:PARTNERS IN CHILDREN'S HEALTH,S.C.
Entity Type:Organization
Organization Name:PARTNERS IN CHILDREN'S HEALTH,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHPA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAMTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-754-5010
Mailing Address - Street 1:2550 HAUSER ROSS DR
Mailing Address - Street 2:SUITE #350
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3149
Mailing Address - Country:US
Mailing Address - Phone:815-754-5010
Mailing Address - Fax:
Practice Address - Street 1:2550 HAUSER ROSS DR
Practice Address - Street 2:SUITE #350
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3149
Practice Address - Country:US
Practice Address - Phone:815-754-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064091261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376527168OtherNPI
IL036064091Medicaid
1376527168OtherNPI
ILE01844Medicare UPIN