Provider Demographics
NPI:1356552533
Name:HOPSCOTCH LLC
Entity type:Organization
Organization Name:HOPSCOTCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:YABUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-844-1248
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60011-3046
Mailing Address - Country:US
Mailing Address - Phone:847-844-1248
Mailing Address - Fax:847-844-1287
Practice Address - Street 1:1141 E MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2440
Practice Address - Country:US
Practice Address - Phone:847-844-1248
Practice Address - Fax:847-844-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-27
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007055591OtherAETNA
IL0001635078OtherBLUE CROSS BLUE SHIELDS
IL036085422Medicaid