Provider Demographics
NPI:1538597117
Name:WAUKEGAN CLINIC CORP
Entity type:Organization
Organization Name:WAUKEGAN CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:4000 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6325
Mailing Address - Country:US
Mailing Address - Phone:615-628-6038
Mailing Address - Fax:
Practice Address - Street 1:1025 RED OAK LN
Practice Address - Street 2:SUITE 120
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-5017
Practice Address - Country:US
Practice Address - Phone:847-336-6111
Practice Address - Fax:847-336-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies