Provider Demographics
NPI:1780960666
Name:NATURE FIRST MEDICAL CLINIC, SC
Entity type:Organization
Organization Name:NATURE FIRST MEDICAL CLINIC, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-263-0480
Mailing Address - Street 1:1800 NATIONS DRIVE SUITE 112
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-263-0480
Mailing Address - Fax:847-263-0590
Practice Address - Street 1:1800 NATIONS DRIVE SUITE 112
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9168
Practice Address - Country:US
Practice Address - Phone:847-263-0480
Practice Address - Fax:847-263-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.084044251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health