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DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE SC NPI 1407966302


NPI Information

NPI: 1407966302
Provider Name: DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE, SC
Classification: Internal Medicine - 207RG0100X
Entity Type: Organization

Specialization: Gastroenterology

CLIA Number: 14D0898770

Address:
1615 N. CONVENT ST
STE 1
BOURBONNAIS, IL
ZIP 60914
Phone: (815) 937-5200
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DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE, SC is a gastroenterology internal medicine in Bourbonnais, IL. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. DIGESTIVE DISEASES CONSULTANTS OF KANKAKEE, SC NPI is 1407966302. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1615 N. CONVENT ST
STE 1
BOURBONNAIS, IL
ZIP 60914
Phone: (815) 937-5200
Fax: (815) 937-2063

The provider's authorized official is Christina M O'connor .
The authorized official title is Administrator and has the following contact phone number (815) 602-8253.

The CLIA number assigned to this NPI record is 14D0898770 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 11/21/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207RG0100XInternal MedicineGastroenterologyILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1326110MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
21407966302MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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