Lake County Internal Medicine Assoc LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

036093940 Issued in IL

Legal business name

LAKE COUNTY INTERNAL MEDICINE ASSOC LLC

Practice address

15 Tower CT.
Ste 190
Gurnee, IL 60031

Phone

(888) 590-0808

Fax

(866) 740-4689

NPI assigned

Apr 16, 2018

Organization subpart

No

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

Authorized official

Name

Mackenzie Hahn

Title

Ncpdp Coordinator

Phone

(888) 590-0808

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Lake County Internal Medicine Assoc LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Lake County Internal Medicine Associates, LLC

  • Internal Medicine Physician
  • Long Grove, IL
  • NPI 1154686525
  NPD tax ID
• Lake County Internal Medicine Association LLC

  • Legal Medicine
  • Long Grove, IL
  • NPI 1265833958
  NPD tax ID

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1316434376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RITTENHOUSE CIRCLE",
            "address_2": "EAST BUILDING STE 5",
            "city": "BRISTOL",
            "state": "PA",
            "postal_code": "19007",
            "telephone_number": "888-590-0808",
            "fax_number": "866-740-4689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 TOWER CT.",
            "address_2": "STE 190",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "888-590-0808",
            "fax_number": "866-740-4689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY INTERNAL MEDICINE ASSOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "HAHN",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "NCPDP COORDINATOR",
        "authorized_official_telephone_number": "888-590-0808"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "IL",
            "license": "036093940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Accident and Injury Center
• Lake County Acute Care, LLP
• Lake County Center, LLC
• Lake County General and Vascular Surgical Associates, P.C.
• Lake County Head and Neck Specialists S.C.
• Lake County Pediatrics SC
• Lake County Primary Care S.C.
• Lake County Vein Specialists, SC
• Lake Harbor Behavioral Health, LLC
• Lake Heart Specialists (Drs. Jajeh & Koch SC)

• Non-Pharmacy Dispensing Site in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Non-Pharmacy Dispensing Site in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.