Provider Demographics
NPI:1740396225
Name:HAMPSHIRE CLINIC SC
Entity Type:Organization
Organization Name:HAMPSHIRE CLINIC SC
Other - Org Name:HAMPSHIRE CLINIC INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-995-6635
Mailing Address - Street 1:153 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-7010
Mailing Address - Country:US
Mailing Address - Phone:847-683-3661
Mailing Address - Fax:
Practice Address - Street 1:153 S STATE ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-7010
Practice Address - Country:US
Practice Address - Phone:847-683-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL561730Medicare ID - Type Unspecified