Provider Demographics
NPI:1215026299
Name:NAPERVILLE CHILDRENS CLINIC
Entity Type:Organization
Organization Name:NAPERVILLE CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-961-1341
Mailing Address - Street 1:1831 BAYSCOTT CIRCLE
Mailing Address - Street 2:STE 109
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-961-1341
Mailing Address - Fax:630-961-1782
Practice Address - Street 1:1831 BAY SCOTT CIR
Practice Address - Street 2:STE 109
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1114
Practice Address - Country:US
Practice Address - Phone:630-961-1341
Practice Address - Fax:630-961-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========OtherTAX ID NUMBER