Provider Demographics
NPI:1134358989
Name:INTERVENTION ARMS MEDICAL CENTER 2 LLC
Entity type:Organization
Organization Name:INTERVENTION ARMS MEDICAL CENTER 2 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHARLES FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:847-599-7783
Mailing Address - Street 1:1809 SHERIDAN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-599-7783
Mailing Address - Fax:224-399-9967
Practice Address - Street 1:1809 SHERIDAN
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-599-7783
Practice Address - Fax:224-399-9967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTION ARMS MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty