Provider Demographics
NPI:1942547229
Name:SYCAMORE INTEGRATED HEALTH, LTD
Entity type:Organization
Organization Name:SYCAMORE INTEGRATED HEALTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-895-3354
Mailing Address - Street 1:920 W PRAIRIE DR STE J
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3123
Mailing Address - Country:US
Mailing Address - Phone:815-895-3354
Mailing Address - Fax:815-895-3345
Practice Address - Street 1:920 W PRAIRIE DR STE J
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3123
Practice Address - Country:US
Practice Address - Phone:815-895-3354
Practice Address - Fax:815-895-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209026220OtherPROVIDER LICENSE NUMBER
IL038011487OtherPROVIDER LICENSE NUMBER
IL038011770OtherPROVIDER LICENSE NUMBER
IL038014224OtherPROVIDER LICENSE NUMBER
IL038011552OtherPROVIDER LICENSE NUMBER
IL209025054OtherPROVIDER LICENSE NUMBER