NPIMap

Organization Active NPI

D

  • Prison Health Clinic/Center
  • St Charles, IL
National Provider Identifier
1902152846
Registry record updated Jul 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prison Health Clinic/CenterTaxonomy code 261QP2400X
License
209.004846 Issued in IL
Legal business name
D
Practice address
3825 Campton Hills Dr
St Charles, IL 60175-6062
Phone
(630) 584-0506
NPI assigned
Jul 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2012

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

Authorized official

Name
Stella Munoz, N.D.NPI 1023899275
Title
Nurse Practitioner
Phone
(630) 279-4861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prison Health Clinic/Center 261QP2400X 209.004846 IL Primary

Addresses

Primary practice location

3825 Campton Hills Dr
St Charles, IL 60175-6062

Mailing address

3825 Campton Hills Dr
St Charles, IL 60175-6062
Phone (630) 584-0506

National Provider Directory

National Provider Directory
Tax ID family
D2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3825 Campton Hills Dr
St Charles, IL 60175
Phone (630) 584-0506

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343606400000",
    "number": "1902152846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 CAMPTON HILLS DR",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756062",
            "telephone_number": "630-584-0506",
            "fax_number": "630-584-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 CAMPTON HILLS DR",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601756062",
            "telephone_number": "630-584-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-30",
        "last_updated": "2012-07-30",
        "status": "A",
        "authorized_official_last_name": "MUNOZ",
        "authorized_official_first_name": "STELLA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "630-279-4861",
        "authorized_official_credential": "N.D."
    },
    "taxonomies": [
        {
            "code": "261QP2400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Prison Health",
            "state": "IL",
            "license": "209.004846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.