Provider Demographics
NPI:1285650838
Name:JACQUES PAPAZIAN M.D,S.C.
Entity Type:Organization
Organization Name:JACQUES PAPAZIAN M.D,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-242-0672
Mailing Address - Street 1:4117 S WATER TOWER PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6567
Mailing Address - Country:US
Mailing Address - Phone:618-242-0672
Mailing Address - Fax:618-242-0862
Practice Address - Street 1:4117 S WATER TOWER PL
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6293
Practice Address - Country:US
Practice Address - Phone:618-242-0672
Practice Address - Fax:618-242-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093598207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL293973OtherHEALTHLINK PROVIDER ID#
IL55563OtherGHP PROVIDER ID#
IL04127654OtherBCBS OF IL PROVIDER#
IL036093598Medicaid
IL040009944OtherRAILROAD MEDICARE ID#
IL027794OtherHEALTH ALLIANCE ID#
IL036093598Medicaid
IL=========OtherEMPLOYER ID#
IL027794OtherHEALTH ALLIANCE ID#