Provider Demographics
NPI:1669502688
Name:SRI MEDICAL CARE SC
Entity Type:Organization
Organization Name:SRI MEDICAL CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMADEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVARAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-226-1800
Mailing Address - Street 1:PO BOX 5339
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5301
Mailing Address - Country:US
Mailing Address - Phone:574-273-6546
Mailing Address - Fax:574-273-5295
Practice Address - Street 1:420 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4925
Practice Address - Country:US
Practice Address - Phone:574-273-6546
Practice Address - Fax:574-273-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
IL211446Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER