Provider Demographics
NPI:1679993471
Name:UIC CLINIC
Entity Type:Organization
Organization Name:UIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CUSTOMER SERVICE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-333-2180
Mailing Address - Street 1:2605 S INDIANA AVE UNIT 606
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2865
Mailing Address - Country:US
Mailing Address - Phone:312-504-7972
Mailing Address - Fax:
Practice Address - Street 1:2605 S INDIANA AVE UNIT 606
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2865
Practice Address - Country:US
Practice Address - Phone:312-504-7972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL018001794390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty