Provider Demographics
NPI:1962036921
Name:NORTHERN ILLINOIS MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-595-6101
Mailing Address - Street 1:3701 DOTY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7509
Mailing Address - Country:US
Mailing Address - Phone:815-338-2910
Mailing Address - Fax:815-338-2912
Practice Address - Street 1:3701 DOTY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7509
Practice Address - Country:US
Practice Address - Phone:815-338-2910
Practice Address - Fax:815-338-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)