Provider Demographics
NPI:1861650889
Name:ROY J. BETTI, M.D.S.C.
Entity Type:Organization
Organization Name:ROY J. BETTI, M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-653-5115
Mailing Address - Street 1:381 S SCHMALE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2782
Mailing Address - Country:US
Mailing Address - Phone:630-653-5115
Mailing Address - Fax:630-653-4493
Practice Address - Street 1:381 S SCHMALE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2782
Practice Address - Country:US
Practice Address - Phone:630-653-5115
Practice Address - Fax:630-653-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043734Medicaid
IL3631498336019001OtherCDPG HFS PAYEE ID
IL02200852OtherBLUE CROSS AND BLUE SHIELD
IL03000104OtherILLINOIS HEALTH CONNECT