Provider Demographics
NPI:1174502611
Name:TRI-CITY NEUROLOGY SC
Entity Type:Organization
Organization Name:TRI-CITY NEUROLOGY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHLAGETER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-587-2068
Mailing Address - Street 1:2210 DEAN ST STE D
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1059
Mailing Address - Country:US
Mailing Address - Phone:630-587-2068
Mailing Address - Fax:630-587-2081
Practice Address - Street 1:2210 DEAN ST STE D
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1059
Practice Address - Country:US
Practice Address - Phone:630-587-2068
Practice Address - Fax:630-587-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K14614OtherMEDICARE
130017803OtherRAILROAD MEDICARE
IL4522081OtherBCBS
IL036060880Medicaid
163660582166OtherHUMANA
4740209004OtherCIGNA
5338653OtherAETNA
A76233Medicare UPIN
210939Medicare ID - Type Unspecified