Provider Demographics
NPI:1942415609
Name:ADVANCED PHYSICAL MEDICINE OF YORKVILLE, LTD
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE OF YORKVILLE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:POCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-553-2111
Mailing Address - Street 1:207 HILLCREST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1393
Mailing Address - Country:US
Mailing Address - Phone:630-553-2111
Mailing Address - Fax:630-553-0022
Practice Address - Street 1:207 HILLCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1393
Practice Address - Country:US
Practice Address - Phone:630-553-2111
Practice Address - Fax:630-553-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096782261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG13723Medicare UPIN