Provider Demographics
NPI:1902843360
Name:OAK PARK VA CLINIC
Entity Type:Organization
Organization Name:OAK PARK VA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-254-0339
Mailing Address - Street 1:149 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2901
Mailing Address - Country:US
Mailing Address - Phone:708-386-3008
Mailing Address - Fax:708-386-3189
Practice Address - Street 1:149 S OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2901
Practice Address - Country:US
Practice Address - Phone:708-386-3008
Practice Address - Fax:708-386-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA