Provider Demographics
NPI:1437113248
Name:LAKE BARRINGTON WOMEN'S HEALTH CENTER, PC
Entity type:Organization
Organization Name:LAKE BARRINGTON WOMEN'S HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-382-7330
Mailing Address - Street 1:2298 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-2561
Mailing Address - Country:US
Mailing Address - Phone:847-854-8542
Mailing Address - Fax:847-854-2909
Practice Address - Street 1:2298 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2561
Practice Address - Country:US
Practice Address - Phone:847-854-8542
Practice Address - Fax:847-854-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCL2981OtherRR MEDICARE
IL04900984OtherBLUE CROSS BLUE SHIELD
IL04900984OtherBLUE CROSS BLUE SHIELD