Kishwaukee Corporate Health @Moi

Primary specialty

Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X

License

036-077643 Issued in IL

Legal business name

KISHWAUKEE CORPORATE HEALTH @MOI

Practice address

2111 Midlands CT
Suite 201
Sycamore, IL 60178-3125

Phone

(181) 575-4488

NPI assigned

Jan 22, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Patrick G Gannon, DO

Title

Physician

Phone

(815) 754-4882

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Kishwaukee Corporate Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Kishwaukee Corporate Health

  • Corporate Health Clinic/Center
  • Dekalb, IL
  • NPI 1255594545
  NPD tax ID

Locations

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

{
    "created_epoch": "1421884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1467841809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "address_2": "SUITE 201",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "60178",
            "telephone_number": "181-575-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 MIDLANDS CT",
            "address_2": "SUITE 201",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783125",
            "telephone_number": "181-575-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISHWAUKEE CORPORATE HEALTH @MOI",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-22",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "GANNON",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "815-754-4882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "IL",
            "license": "036-077643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMP",
            "identifier": "1255594545",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darrin S King, D.D.S.
• Thomas Kirts, M.D.
• Kishwaukee Cardiology Associates, LTD
• Kishwaukee Cardiology Associates, LTD.
• Kishwaukee Community Health Services Center
• Kishwaukee Internist SC
• Kishwaukee Physician Group, Inc.
• Jennifer L. Kleckner, RN, IBCLC
• Collette Ann Klein, RN MSN FPMHNP-BC
• Kevin Kloosterman, M.S., LMFT

• Occupational Medicine Clinic/Center in Sycamore, IL
• Providers in Sycamore, IL by specialty
• Occupational Medicine Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.