Provider Demographics
NPI:1023318458
Name:MEDPOINT HEALTHCARE LLC
Entity type:Organization
Organization Name:MEDPOINT HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-467-9629
Mailing Address - Street 1:PO BOX 71975
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-1975
Mailing Address - Country:US
Mailing Address - Phone:855-237-9112
Mailing Address - Fax:888-467-9635
Practice Address - Street 1:2000 GOLF RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-4216
Practice Address - Country:US
Practice Address - Phone:847-960-5819
Practice Address - Fax:888-467-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540186843336C0003X, 333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148313OtherPK
IL=========001Medicaid