Provider Demographics
NPI:1437628625
Name:THRIVE OB SC
Entity Type:Organization
Organization Name:THRIVE OB SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-277-0500
Mailing Address - Street 1:27750 W HIGHWAY 22 STE 120
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2379
Mailing Address - Country:US
Mailing Address - Phone:847-277-0500
Mailing Address - Fax:847-277-0505
Practice Address - Street 1:27750 W HIGHWAY 22 STE 120
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2379
Practice Address - Country:US
Practice Address - Phone:847-277-0500
Practice Address - Fax:847-277-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125912207V00000X
IL03061346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty