Provider Demographics
NPI:1225684640
Name:HEALTHSTOP SC
Entity Type:Organization
Organization Name:HEALTHSTOP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JETHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-447-9402
Mailing Address - Street 1:3635 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3212
Mailing Address - Country:US
Mailing Address - Phone:708-447-9402
Mailing Address - Fax:708-447-3246
Practice Address - Street 1:3635 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3212
Practice Address - Country:US
Practice Address - Phone:708-447-9402
Practice Address - Fax:708-447-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty