Provider Demographics
NPI:1760647226
Name:JOLIET CENTER FOR CLINICAL RESEARCH, INC
Entity type:Organization
Organization Name:JOLIET CENTER FOR CLINICAL RESEARCH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COSME
Authorized Official - Middle Name:O
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-408-1099
Mailing Address - Street 1:210 N HAMMES AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8139
Mailing Address - Country:US
Mailing Address - Phone:815-729-7790
Mailing Address - Fax:815-725-8144
Practice Address - Street 1:210 N HAMMES AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:815-729-7790
Practice Address - Fax:815-725-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073518924OtherROSEWOOD NPI
1295961886OtherTONY NPI
1316103898OtherNPI
1467473462OtherTRUM NPI
1922143320OtherHILLCREST NPI
IL0136082815Medicaid
1417197690OtherMANDY NPI
1760647226OtherNPI
1922094051OtherOUR LADY OF ANGELS NPI
1487715645OtherST JOE NPI
1689791360OtherSILVER CROSS PSYCH NPI
1013904739OtherSALEM VILLAGE NPI
1134209364OtherJOLIET TERRACE NPI
1427034651OtherDEERBROOK NPI
1609056001OtherFAIRVIEW NPI
1003976713OtherST JOE PSYCH NPI
1568553519OtherSILVER CROSS NPI
1407971716OtherLAKEWOOD NPI
1780740209OtherEMBASSY NPI
1780740209OtherEMBASSY NPI
1760647226OtherNPI
1003976713OtherST JOE PSYCH NPI
IL0136082815Medicaid
DO1399Medicare PIN
IL145761Medicare PIN
ILF20161Medicare UPIN