Provider Demographics
NPI:1841395092
Name:VALLEY EMERGENCY CARE MANAGEMENT, INC.
Entity type:Organization
Organization Name:VALLEY EMERGENCY CARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-667-9587
Mailing Address - Street 1:PO BOX 9030
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-9030
Mailing Address - Country:US
Mailing Address - Phone:847-495-1624
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:300 RANDALL RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4200
Practice Address - Country:US
Practice Address - Phone:630-208-4009
Practice Address - Fax:630-208-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2025-01-16
Deactivation Date:2024-10-01
Deactivation Code:
Reactivation Date:2024-11-08
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0451530938OtherBLUE SHIELD GROUP NUMBER
ILCC0707OtherRAILROAD MEDICARE GROUP
ILCC0707OtherRAILROAD MEDICARE GROUP