Provider Demographics
NPI:1245304260
Name:SILVER CROSS MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:SILVER CROSS MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KREPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-740-7084
Mailing Address - Street 1:1200 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-1439
Mailing Address - Country:US
Mailing Address - Phone:815-740-1100
Mailing Address - Fax:815-740-4703
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-740-1100
Practice Address - Fax:815-740-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL528890Medicare ID - Type Unspecified