Provider Demographics
NPI:1467402131
Name:VERTICAL PLUS OF HAZEL CREST
Entity Type:Organization
Organization Name:VERTICAL PLUS OF HAZEL CREST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-799-4940
Mailing Address - Street 1:3330 W 177TH ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2001
Mailing Address - Country:US
Mailing Address - Phone:708-799-4940
Mailing Address - Fax:
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2001
Practice Address - Country:US
Practice Address - Phone:708-799-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL211260Medicare ID - Type UnspecifiedPROVIDER NUMBER