Provider Demographics
NPI:1881946200
Name:TRAVEL PHYSICIANS, SC
Entity type:Organization
Organization Name:TRAVEL PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNWOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:847-981-3694
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:BROCK SUITE 4011
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3694
Mailing Address - Fax:847-981-6508
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:BROCK SUITE 4011
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3694
Practice Address - Fax:847-981-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042620046261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service