Provider Demographics
NPI:1801886221
Name:NORTHWEST GASTROENTEROLOGISTS SC
Entity type:Organization
Organization Name:NORTHWEST GASTROENTEROLOGISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-439-1005
Mailing Address - Street 1:1415 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3765
Mailing Address - Country:US
Mailing Address - Phone:847-439-1005
Mailing Address - Fax:847-439-7555
Practice Address - Street 1:1415 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3765
Practice Address - Country:US
Practice Address - Phone:847-439-1005
Practice Address - Fax:847-439-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1616208OtherBCBS OF IL
634730Medicare ID - Type Unspecified