Provider Demographics
NPI:1841690823
Name:INTERVENTION ARMS MEDICAL CENTER
Entity type:Organization
Organization Name:INTERVENTION ARMS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-785-0611
Mailing Address - Street 1:1809 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-2235
Mailing Address - Country:US
Mailing Address - Phone:847-785-0611
Mailing Address - Fax:847-785-0617
Practice Address - Street 1:1809 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-2235
Practice Address - Country:US
Practice Address - Phone:847-785-0611
Practice Address - Fax:847-785-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054557Medicaid
IL490770Medicare PIN
IL036054557Medicaid