NPIMap

Organization Active NPI

PHC of Buffalo Grove Diagnostic Services

Doing business as Portrait Health Centers Diagnostic Services

  • Physiological Laboratory
  • Buffalo Grove, IL
National Provider Identifier
1881975266
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
PHC OF BUFFALO GROVE DIAGNOSTIC SERVICES
Doing business as
Portrait Health Centers Diagnostic Services
Practice address
150 W Half Day Rd
Suite 105
Buffalo Grove, IL 60089-6591
Phone
(847) 868-3435
Fax
(847) 859-5885
NPI assigned
Aug 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Authorized official

Name
Dr. Jack A Maggiore, PHD
Title
Director
Phone
(847) 868-3435

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TH0100X
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

150 W Half Day Rd
Suite 105
Buffalo Grove, IL 60089-6591

Mailing address

150 W Half Day Rd
Suite 105
Buffalo Grove, IL 60089-6591
Phone (847) 868-3435

Other names 1

  • Portrait Health Centers Diagnostic Services Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314748800000",
    "number": "1881975266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W HALF DAY RD",
            "address_2": "SUITE 105",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600896591",
            "telephone_number": "847-868-3435",
            "fax_number": "847-859-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W HALF DAY RD",
            "address_2": "SUITE 105",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600896591",
            "telephone_number": "847-868-3435",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC OF BUFFALO GROVE DIAGNOSTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2011-08-31",
        "status": "A",
        "authorized_official_last_name": "MAGGIORE",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-868-3435",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portrait Health Centers Diagnostic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2011; 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.