| Organization Name: | NAVAL HEALTH CLINIC GREAT LAKES ILLINOIS |
| NPI Number: | 1093044281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHNNA ANN MORTON (INDEPENDENT HOSPITAL CORPSMAN) |
| Mailing Address: | 3350 Illinois St Bldg 1523 Great Lakes |
| State: | IL US |
| Postal Code: | 600885230 |
| Phone Number: | 8476885568 |
| Fax Number: | 8476884430 |
| NPI Enumeration Date: | 12/17/2009 |
| NPI Last Update Date: | 12/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1102X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military Outpatient Operational (Transportable) Component |
| Taxonomy Definition: | |