Provider Demographics
NPI:1770777583
Name:HEALTH ONE MEDICAL CENTER SC
Entity type:Organization
Organization Name:HEALTH ONE MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPYROS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-470-1177
Mailing Address - Street 1:8424 SKOKIE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2568
Mailing Address - Country:US
Mailing Address - Phone:847-470-1177
Mailing Address - Fax:847-470-0368
Practice Address - Street 1:8424 SKOKIE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-470-1177
Practice Address - Fax:847-470-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006760261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL572220OtherMEDICARE PROVIDER NUMBER
IL572220OtherMEDICARE PROVIDER NUMBER