Provider Demographics
NPI:1912195595
Name:BABICH SKIN CARE CENTER, INC.
Entity Type:Organization
Organization Name:BABICH SKIN CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-876-6890
Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-876-6890
Mailing Address - Fax:217-876-6895
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 313
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-876-6890
Practice Address - Fax:217-876-6895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-09961207N00000X
IL036-099961207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL007694141OtherAETNA
ILP00132612OtherMEDICARE R.R.
IL099085OtherHEALTH ALLIANCE
IL5832043OtherBLUE CROSS
ILK06689Medicare PIN
IL007694141OtherAETNA