Provider Demographics
NPI:1780944264
Name:MVC - NILES, S.C.
Entity type:Organization
Organization Name:MVC - NILES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-322-9126
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1050
Mailing Address - Country:US
Mailing Address - Phone:630-322-9126
Mailing Address - Fax:630-322-9128
Practice Address - Street 1:7177 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4424
Practice Address - Country:US
Practice Address - Phone:630-322-9126
Practice Address - Fax:630-322-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty