Oak Brook Clinic, LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

OAK BROOK CLINIC, LLC

Practice address

2605 W 22ND St Ste 29
Oak Brook, IL 60523-4625

Phone

(630) 819-8100

Fax

(630) 568-3362

NPI assigned

Mar 19, 2020

Organization subpart

No

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

Authorized official

Name

Jim P Weiss

Title

Director of Quality Management

Phone

(402) 339-1436

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1508492745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 W 22ND ST STE 29",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605234625",
            "telephone_number": "630-819-8100",
            "fax_number": "630-568-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 W 22ND ST STE 29",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605234625",
            "telephone_number": "630-819-8100",
            "fax_number": "630-568-3362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK BROOK CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "WEISS",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY MANAGEMENT",
        "authorized_official_telephone_number": "402-339-1436"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS, SUPR",
            "identifier": "A-2158-0000-A",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Practiceaddress",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": ".",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": ".",
            "address_1": "2605 W 22nd St Ste 29",
            "city": "Oak Brook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605234625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Oak Brook Dental Associates
• Oak Brook Dental Center Inc.
• Oak Brook Dental Group

• Methadone Clinic in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
• Methadone Clinic in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.