Aunt Matha's Youth Service Center

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

1275992323 Issued in IL

Legal business name

AUNT MATHA'S YOUTH SERVICE CENTER

Practice address

19990 Governors Hwy
Olympia Fields, IL 60461-1021

Phone

(708) 747-7100

NPI assigned

Apr 5, 2016

Last updated

Apr 5, 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

Dr. Clarence Parks, MD

Title

PCP - Family Practice Medicine

Phone

(815) 275-1540

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Arthur Pilapil Oliveros, FNP-BC (DNP)

  • Family Nurse Practitioner
  • Olympia Fields, IL
  • NPI 1275992323
  NPD (past)

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1902269095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "898 BROMPTON CIR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401485",
            "telephone_number": "847-420-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19990 GOVERNORS HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611021",
            "telephone_number": "708-747-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MATHA'S YOUTH SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_title_or_position": "PCP - FAMILY PRACTICE MEDICINE",
        "authorized_official_telephone_number": "815-275-1540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "IL",
            "license": "1275992323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PLAN & PROVIDER ENUMERATION",
            "identifier": "1275992323",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aunt Martha's Health and Wellness
• Aunt Martha's Health and Wellness, Inc. (Aunt Martha's Youth Service Center, Inc.)
• Aunt Marthas Youth Service
• Aunt Marthas Youth Service Center
• Aunt Marthas Youth Service Center, Inc
• Brennan Scott Ayres, DO
• Shahnaz Azad, M.D.
• Hassan G Azar, MD
• Mayar Azar
• Muhammad Jaafar Baba, MD

• Health Service Clinic/Center in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Health Service Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.