Active NPI
Highland Park CVS LLC
Doing business as CVS Pharmacy #11205
- Pharmacy
- Metamora, IL
National Provider Identifier
1821073156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- HIGHLAND PARK CVS LLC
- Doing business as
- CVS Pharmacy #11205
- Practice address
- 117 W Mt. Vernon
Metamora, IL 61548-7000 - Phone
- (309) 367-9701
- Fax
- (309) 367-2159
- NPI assigned
- Dec 9, 2005
- Last updated
- May 25, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Susan Colbert
- Title
- Sr. Director, Payer Relations
- Phone
- (401) 770-2751
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | Primary | ||
| Community/Retail Pharmacy | 3336C0003X | 054018987 | IL |
Addresses
Primary practice location
117 W Mt. Vernon
Metamora, IL 61548-7000
Mailing address
1 CVS Drive
Box 1075
Woonsocket, RI 02895-6146
Phone (401) 765-1500
Other names 1
- CVS Pharmacy #11205
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080103000235 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 2860572856 | This NPI is an additional NPI on the enrollment |
| O20180407000066 | IL | DME Supplier - Pharmacy | 2860572856 | Practice locations: Metamora, IL |
National Provider Directory
National Provider Directory- Tax ID family
- Highland Park CVS LLC
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1684972800000",
"number": "1821073156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CVS DRIVE",
"address_2": "BOX 1075",
"city": "WOONSOCKET",
"state": "RI",
"postal_code": "028956146",
"telephone_number": "401-765-1500",
"fax_number": "937-428-7978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 W MT. VERNON",
"city": "METAMORA",
"state": "IL",
"postal_code": "615487000",
"telephone_number": "309-367-9701",
"fax_number": "309-367-2159"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HIGHLAND PARK CVS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-09",
"last_updated": "2023-05-25",
"certification_date": "2023-05-25",
"status": "A",
"authorized_official_last_name": "COLBERT",
"authorized_official_first_name": "SUSAN",
"authorized_official_title_or_position": "SR. DIRECTOR, PAYER RELATIONS",
"authorized_official_telephone_number": "401-770-2751"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "IL",
"license": "054018987",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Pharmacy #11205",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Metamora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.