Provider Demographics
NPI:1477723823
Name:VANCOL FAMILY HEALTH CENTER SC
Entity Type:Organization
Organization Name:VANCOL FAMILY HEALTH CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-846-9521
Mailing Address - Street 1:8646 S SAGINAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2422
Mailing Address - Country:US
Mailing Address - Phone:773-575-7447
Mailing Address - Fax:773-846-9523
Practice Address - Street 1:67 W 111TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4247
Practice Address - Country:US
Practice Address - Phone:773-575-7447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633398OtherBLUECROSS BLUESHIELD
IL572400Medicare PIN
IL0001633398OtherBLUECROSS BLUESHIELD