Uic

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Legal business name

UIC

Practice address

1740 W Taylor St
Chicago, IL 60612-7232

Phone

(866) 600-2273

NPI assigned

Apr 17, 2016

Last updated

Apr 17, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jasma McDonald

Title

Pediatric Dental Residency

Phone

(256) 606-5080

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1460851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460851200000",
    "number": "1750735759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 COUNTY ROAD 599",
            "city": "MOULTON",
            "state": "AL",
            "postal_code": "356505700",
            "telephone_number": "256-606-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127232",
            "telephone_number": "866-600-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-17",
        "last_updated": "2016-04-17",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "JASMA",
        "authorized_official_title_or_position": "PEDIATRIC DENTAL RESIDENCY",
        "authorized_official_telephone_number": "256-606-5080"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Chicago, IL
• Providers in Chicago, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2016; 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.