Provider Demographics
NPI:1790834547
Name:REPRODUCTIVE HEALTH ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:REPRODUCTIVE HEALTH ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-798-1434
Mailing Address - Street 1:17850 KEDZIE AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2058
Mailing Address - Country:US
Mailing Address - Phone:708-798-2400
Mailing Address - Fax:708-798-0776
Practice Address - Street 1:17850 SO. KEDZIE
Practice Address - Street 2:SUITE 3100
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2086
Practice Address - Country:US
Practice Address - Phone:708-798-2400
Practice Address - Fax:708-798-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL042007851OtherPRACTICE-LICENSE