Active NPI
Thomas Waller
- Driver
- South Holland, IL
National Provider Identifier
1518113067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- W46082583086
- Practice address
- 430 E 162ND St
Suite 522
South Holland, IL 60473-2258 - Phone
- (773) 895-3921
- Fax
- (708) 575-0432
- NPI assigned
- Aug 15, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | W46082583086 | IL | Primary |
Addresses
Primary practice location
430 E 162ND St
Suite 522
South Holland, IL 60473-2258
Mailing address
430 E 162ND St
Suite 522
South Holland, IL 60473-2258
Phone (773) 895-3921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| W46082583086 | IL | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218758400000",
"number": "1518113067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 E 162ND ST",
"address_2": "SUITE 522",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604732258",
"telephone_number": "773-895-3921",
"fax_number": "708-575-0432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 E 162ND ST",
"address_2": "SUITE 522",
"city": "SOUTH HOLLAND",
"state": "IL",
"postal_code": "604732258",
"telephone_number": "773-895-3921",
"fax_number": "708-575-0432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "THOMAS",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-15",
"last_updated": "2008-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "IL",
"license": "W46082583086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Holland, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.