Lockport Medical Wellness LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LOCKPORT MEDICAL WELLNESS LLC

Practice address

27475 Ferry Rd
Warrenville, IL 60555-3808

Phone

(718) 554-1042

NPI assigned

Sep 8, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Varun Bajaj

Title

Biller

Phone

(718) 554-1024

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541980800000",
    "number": "1093233199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27475 FERRY RD",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553808",
            "telephone_number": "718-554-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27475 FERRY RD",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553808",
            "telephone_number": "718-554-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCKPORT MEDICAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2018-11-12",
        "status": "A",
        "authorized_official_last_name": "BAJAJ",
        "authorized_official_first_name": "VARUN",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "718-554-1024"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Warrenville, IL
• Providers in Warrenville, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.