Provider Demographics
NPI:1356523534
Name:NAPERVILLE HEALTH CLINIC, S.C.
Entity type:Organization
Organization Name:NAPERVILLE HEALTH CLINIC, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-274-9400
Mailing Address - Street 1:404 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-2002
Mailing Address - Country:US
Mailing Address - Phone:309-274-9400
Mailing Address - Fax:309-274-9430
Practice Address - Street 1:404 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2002
Practice Address - Country:US
Practice Address - Phone:309-274-9400
Practice Address - Fax:309-274-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209138Medicare PIN