Provider Demographics
NPI:1215194519
Name:MATHERS CLINIC, LLC
Entity Type:Organization
Organization Name:MATHERS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:VEMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-397-7654
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3479
Mailing Address - Country:US
Mailing Address - Phone:773-775-2800
Mailing Address - Fax:773-775-3366
Practice Address - Street 1:5804 ELAINE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2435
Practice Address - Country:US
Practice Address - Phone:815-397-7654
Practice Address - Fax:815-397-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360392662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty