Sa Padua Medical Center, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036119492 Issued in IL

Legal business name

SA PADUA MEDICAL CENTER, LLC

Practice address

2310 York St
Suite 2C
Blue Island, IL 60406-2411

Phone

(708) 388-4902

NPI assigned

Dec 15, 2009

Organization subpart

No

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

Authorized official

Name

Jerome Jabbour, M.D.

Title

President

Phone

(219) 836-9024

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1260835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1396074753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212807",
            "telephone_number": "219-836-9024",
            "fax_number": "219-836-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 YORK ST",
            "address_2": "SUITE 2C",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604062411",
            "telephone_number": "708-388-4902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SA PADUA MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-15",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "JABBOUR",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-836-9024",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036119492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janae Neycole Rogers, M.ED.
• Alan Marshall Roman, MD
• Ronnie Ata Consulting
• Natalie Ruffner
• Lashon Rushing, PHARM. D.
• Maisha Safford
• Sandra F Salcedo
• Maricsa Sanchez
• Varsovia Santoliva, D.C.
• Louise Sarabia, DDS

• Family Medicine Physician in Blue Island, IL
• Providers in Blue Island, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.