Provider Demographics
NPI:1811944515
Name:UNITED SHOCKWAVE SERVICES, LTD.
Entity type:Organization
Organization Name:UNITED SHOCKWAVE SERVICES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-544-5853
Mailing Address - Street 1:PO BOX 95439
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-9735
Mailing Address - Country:US
Mailing Address - Phone:877-465-4845
Mailing Address - Fax:847-297-8853
Practice Address - Street 1:1875 W DEMPSTER ST
Practice Address - Street 2:SUITE G04
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-544-5853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617500OtherBLUE CROSS BLUE SHIELD
IL630OtherBLUE CROSS BLUE SHIELD
IL750320Medicare PIN
IL1617500OtherBLUE CROSS BLUE SHIELD
ILIL6210Medicare PIN
IL201914Medicare PIN