Provider Demographics
NPI:1144557208
Name:NAVAL HEALTH CLINIC GREAT LAKES
Entity type:Organization
Organization Name:NAVAL HEALTH CLINIC GREAT LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-688-6712
Mailing Address - Street 1:3350 ILLINOIS STREET BLDG 1523
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:60088-5230
Mailing Address - Country:US
Mailing Address - Phone:846-688-5568
Mailing Address - Fax:847-688-2289
Practice Address - Street 1:3350 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5230
Practice Address - Country:US
Practice Address - Phone:847-688-5568
Practice Address - Fax:847-688-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient