Provider Demographics
NPI:1245830967
Name:CAPTAIN JAMES A LOVELL FEDERAL HEALTH CARE CENTER
Entity type:Organization
Organization Name:CAPTAIN JAMES A LOVELL FEDERAL HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT TO THE CME
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-610-3009
Mailing Address - Street 1:3001 GREEN BAY RD BLDG 7
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:224-610-3852
Practice Address - Street 1:3001 GREEN BAY RD BLDG 7
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-627-2804
Practice Address - Fax:224-610-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA