Provider Demographics
NPI:1811920812
Name:VASCULAR ACCESS CENTERS OF CHICAGO LLC
Entity type:Organization
Organization Name:VASCULAR ACCESS CENTERS OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:322 S GREEN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3555
Mailing Address - Country:US
Mailing Address - Phone:312-666-0486
Mailing Address - Fax:
Practice Address - Street 1:322 S GREEN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3555
Practice Address - Country:US
Practice Address - Phone:312-666-0486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL=========Medicaid