Provider Demographics
NPI:1518145176
Name:INTERVENTION ARMS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:INTERVENTION ARMS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHARLES FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-785-0611
Mailing Address - Street 1:1809 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-2235
Mailing Address - Country:US
Mailing Address - Phone:847-785-0611
Mailing Address - Fax:847-785-0617
Practice Address - Street 1:1809 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2235
Practice Address - Country:US
Practice Address - Phone:847-785-0611
Practice Address - Fax:847-785-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085005371Medicaid
IL036054557Medicaid
IL085001395Medicaid
IL036102939Medicaid
IL036065847Medicaid
IL085001395Medicaid
IL036065847Medicaid