Babich Skin Care Center, Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036-09961 Issued in IL

Legal business name

BABICH SKIN CARE CENTER, INC.

Practice address

304 W Hay St
Suite 313
Decatur, IL 62526-6328

Phone

(217) 876-6890

Fax

(217) 876-6895

NPI assigned

Oct 9, 2007

Last updated

Oct 10, 2007By 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

Mr. Samuel Babich

Title

Practice Manager

Phone

(217) 876-6890

Specialties & licenses 2

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1912195595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W HAY ST",
            "address_2": "SUITE 313",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266328",
            "telephone_number": "217-876-6890",
            "fax_number": "217-876-6895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 W HAY ST",
            "address_2": "SUITE 313",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266328",
            "telephone_number": "217-876-6890",
            "fax_number": "217-876-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BABICH SKIN CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "BABICH",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "217-876-6890",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-09961",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "036-099961",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "007694141",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE R.R.",
            "identifier": "P00132612",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "099085",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "5832043",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Edward Bacon, LCPC

• Dermatology Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.