Provider Demographics
NPI:1144214644
Name:VISTA FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:VISTA FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VALEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-239-9100
Mailing Address - Street 1:10961 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2219
Mailing Address - Country:US
Mailing Address - Phone:773-239-9100
Mailing Address - Fax:773-239-9102
Practice Address - Street 1:10961 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2219
Practice Address - Country:US
Practice Address - Phone:773-239-9100
Practice Address - Fax:773-239-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053305557OtherPROVIDER NPI
ILDF2121OtherMEDICARE RAILROAD (GROUP)
ILP00347253OtherMEDICARE RAILROAD (VALEK)
IL1235321704OtherPROVIDER NPI
IL1235321704OtherPROVIDER NPI
ILP00347253OtherMEDICARE RAILROAD (VALEK)
ILK24729Medicare PIN