Kankakee Valley OB/GYN,LLC

Primary specialty

Legal MedicineTaxonomy code 173000000X

Legal business name

KANKAKEE VALLEY OB/GYN,LLC

Practice address

375 N Wall Street
Suite P630
Kankakee, IL 60901

Phone

(815) 933-4510

Fax

(815) 933-4259

NPI assigned

Oct 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tapan Ashvin Mehta, M.D.

Title

Owner

Phone

(815) 933-4510

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1134212665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 N WALL STREET",
            "address_2": "SUITE P630",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-933-4510",
            "fax_number": "815-933-4259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 N WALL STREET",
            "address_2": "SUITE P630",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "60901",
            "telephone_number": "815-933-4510",
            "fax_number": "815-933-4259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANKAKEE VALLEY OB/GYN,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "TAPAN",
        "authorized_official_middle_name": "ASHVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-933-4510",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "04628061",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Charles Jonathan Kay, D.D.S.
• Keith M. Monson, M.D., SC
• Debbie Kelly, PTA

• Legal Medicine in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Legal Medicine in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.