Provider Demographics
NPI:1801315049
Name:SYNERGENX HEALTH - MOKENA LLC
Entity type:Organization
Organization Name:SYNERGENX HEALTH - MOKENA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-970-5900
Mailing Address - Street 1:16131 N ELDRIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-9130
Mailing Address - Country:US
Mailing Address - Phone:281-970-5900
Mailing Address - Fax:
Practice Address - Street 1:19164 88TH AVE
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8135
Practice Address - Country:US
Practice Address - Phone:708-326-2966
Practice Address - Fax:281-970-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care