NPIMap

Organization Active NPI

Medcentrix Inc

Doing business as Ingalls Proof Phcy

  • Community/Retail Pharmacy
  • Harvey, IL
National Provider Identifier
1346372372
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054016131 Issued in IL
Legal business name
MEDCENTRIX INC
Doing business as
Ingalls Proof Phcy
Practice address
31 W 155TH St
Harvey, IL 60426-3556
Phone
(708) 589-2019
NPI assigned
Mar 13, 2007
Last updated
Feb 4, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Authorized official

Name
Ronald Rutkowski, RPH
Title
Pharmacy Manager
Phone
(815) 703-8434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 054016131 IL Primary

Addresses

Primary practice location

31 W 155TH St
Harvey, IL 60426-3556

Mailing address

31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 589-2019

Other identifiers 1

IdentifierTypeStateIssuer
1480639OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • INGALLS PROOF PHCY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ingalls Professional Pharmacy 410 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1346372372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-589-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-589-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCENTRIX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "RUTKOWSKI",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "815-703-8434",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054016131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1480639",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INGALLS PROOF PHCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harvey, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.