Provider Demographics
NPI:1861866857
Name:DREYER CLINIC, INC
Entity Type:Organization
Organization Name:DREYER CLINIC, INC
Other - Org Name:DREYER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP FINANCIAL OPS
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1610
Mailing Address - Street 1:2357 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-6222
Mailing Address - Country:US
Mailing Address - Phone:630-859-6800
Mailing Address - Fax:
Practice Address - Street 1:80 TEMPLETON DR
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7000
Practice Address - Country:US
Practice Address - Phone:630-554-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANGELICAL SERVICES CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID