Provider Demographics
NPI:1821219551
Name:VAN MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:VAN MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NGAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-267-2627
Mailing Address - Street 1:3637 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5625
Mailing Address - Country:US
Mailing Address - Phone:773-267-2627
Mailing Address - Fax:773-583-8559
Practice Address - Street 1:3637 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5625
Practice Address - Country:US
Practice Address - Phone:773-267-2627
Practice Address - Fax:773-583-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626090OtherBCBS OF IL
IL208532Medicare ID - Type Unspecified
IL1626090OtherBCBS OF IL