Provider Demographics
NPI:1649229840
Name:INTENSIVIST GROUP SC
Entity Type:Organization
Organization Name:INTENSIVIST GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-344-0543
Mailing Address - Street 1:DEPT 4392
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4392
Mailing Address - Country:US
Mailing Address - Phone:866-540-5303
Mailing Address - Fax:
Practice Address - Street 1:800 W CENTRAL ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:866-540-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004932462OtherBLUE SHIELD IL
IL212079Medicare PIN
IL0004932462OtherBLUE SHIELD IL