Provider Demographics
NPI:1578091971
Name:THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS
Other - Org Name:O'HARE URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR ADMINISTRATIVE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-413-0002
Mailing Address - Street 1:7732 SOLUTION CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10000 WEST O'HARE
Practice Address - Street 2:TERMINAL 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-0508
Practice Address - Country:US
Practice Address - Phone:773-894-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ILLINOIS CHICAGO PHYSICIAN GROUP (UICPG)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081301Medicaid
IL338843610001Medicaid
IL036070836Medicaid
IL355387038001Medicaid
IL036083148Medicaid
IL359806839001Medicaid
IL361626360001Medicaid
IL593669702001Medicaid
IL036114380Medicaid
IL0320685617Medicaid
IL324401923001Medicaid