Organization Active NPI

Dr Nicholas M Tabor III DPM

  • Podiatrist
  • Ottawa, IL
National Provider Identifier
1619146016
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
DR NICHOLAS M TABOR III DPM
Practice address
1703 Polaris Cir
Ottawa, IL 61350-1683
Phone
(815) 433-5600
Fax
(815) 434-0933
NPI assigned
Feb 29, 2008
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
DR NICHOLAS M TABOR III DPMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Dr. Nicholas M Tabor III, DPMNPI 1255327441
Title
Owner
Phone
(815) 224-3535

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X NU Primary

Addresses

Primary practice location

1703 Polaris Cir
Ottawa, IL 61350-1683

Mailing address

1703 Polaris Cir
Ottawa, IL 61350-1683
Phone (815) 433-5600

National Provider Directory

National Provider Directory
Part of
Dr Nicholas M Tabor III DPM

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1619146016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 POLARIS CIR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501683",
            "telephone_number": "815-433-5600",
            "fax_number": "815-434-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 POLARIS CIR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501683",
            "telephone_number": "815-433-5600",
            "fax_number": "815-434-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR NICHOLAS M TABOR III DPM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR NICHOLAS M TABOR III DPM",
        "enumeration_date": "2008-02-29",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "TABOR",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-224-3535",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

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

Verify at the official NPI Registry.