Provider Demographics
NPI:1780989905
Name:NORTHERN ILLINOIS MEDICAL CENTER
Entity type:Organization
Organization Name:NORTHERN ILLINOIS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CIO & CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-788-5831
Mailing Address - Street 1:213 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5501
Mailing Address - Country:US
Mailing Address - Phone:815-759-4444
Mailing Address - Fax:
Practice Address - Street 1:213 FRONT ST.
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5501
Practice Address - Country:US
Practice Address - Phone:815-759-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN ILLINOIS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-19
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0833610001Medicare NSC