Organization Name: | DREYER CLINIC, INC |
NPI Number: | 1124492111 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUZANNE M. ROSALES (CFO/CHIEF FINANCIAL OFFICER) |
Mailing Address: | 1500 Sycamore Rd Yorkville |
State: | IL US |
Postal Code: | 605601906 |
Phone Number: | 6305534470 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2015 |
NPI Last Update Date: | 11/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |