Provider Demographics
NPI:1043223688
Name:LX HEALTH ADVOCATE CENTER LTD
Entity Type:Organization
Organization Name:LX HEALTH ADVOCATE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-334-3767
Mailing Address - Street 1:4906 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1922
Mailing Address - Country:US
Mailing Address - Phone:773-334-3767
Mailing Address - Fax:773-334-4931
Practice Address - Street 1:4906 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1922
Practice Address - Country:US
Practice Address - Phone:773-334-3767
Practice Address - Fax:773-334-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008583111N00000X
IL036088691207R00000X, 2081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088691 PAYEE2Medicaid
IL01633171OtherBCBS
IL205905Medicare PIN
IL036088691 PAYEE2Medicaid
ILL97308Medicare PIN
IL205087Medicare ID - Type UnspecifiedMEDICARE GRP