LIFELINE VASCULAR CENTER NICEVILLE LLC (NPI# 1962849794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962849794 |
| Entity Type | Organization |
| Organization Name | LIFELINE VASCULAR CENTER NICEVILLE LLC |
| Practice Address |
3 W Hawthorn Pkwy Suite 410 Vernon Hills IL 60061-1446 |
| Mailing Address |
4585 E Highway 20 Niceville FL 32578-7707 |
| Practice Telephone | 8473882001 |
| Practice Fax Number | 8473882020 |
| Mailing Telephone | 8473882001 |
| Mailing Fax Number | 8473882020 |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2013-06-03 |
| Authorized Official Name | JAMES HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2532809501 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
3 W HAWTHORN PKWY SUITE 410 |
| City | VERNON HILLS |
| State | IL |
| Zip Code | 60061-1446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861594129 | Michael Cullen II | Social Worker | 3 W Hawthorn Pkwy, Suite 260, Vernon Hills, IL 60061-1446 | 2006-09-05 |
| 1053849703 | China Oughton | Marriage & Family Therapist | 3 W Hawthorn Pkwy, Vernon Hills, IL 60061-1446 | 2017-05-25 |
| 1871916494 | Greater Long Beach Peripheral Arterial Disease Center, A Professional | Internal Medicine | 3 W Hawthorn Pkwy, Suite 410, Vernon Hills, IL 60061-1446 | 2014-02-03 |
| 1104168970 | Brigette Muck | Counselor | 3 W Hawthorn Pkwy, Suite 150, Vernon Hills, IL 60061-1446 | 2013-03-20 |
| 1083950356 | Lifeline Pensacola, LLC | Internal Medicine | 3 W Hawthorn Pkwy, Suite 410, Vernon Hills, IL 60061-1446 | 2012-12-14 |
| 1528246261 | Toby S. Perlman | Psychologist | 3 W Hawthorn Pkwy, Suite 150, Vernon Hills, IL 60061-1447 | 2008-02-05 |
| 1255461802 | Robert Joseph Fabsik Jr. | Psychiatry & Neurology | 3 W Hawthorn Pkwy, Suite 260, Vernon Hills, IL 60061-1446 | 2007-03-06 |
| 1558431510 | Sharon Prystalski | Psychologist | 3 W Hawthorn Pkwy, Suite 260, Vernon Hills, IL 60061-1446 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841833399 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | Milwaukee Ave & E Towline Rd #e1600, Vernon Hills, IL 60061 | 2019-10-28 |
| 1124423769 | Deborah Randall | Pharmacist | 706 Summit Ln, Vernon Hills, IL 60061 | 2014-10-24 |
| 1902217938 | Alexandra Kohl Brady | Pediatrics | 830 W End Ct Ste 500, Vernon Hills, IL 60061 | 2014-05-13 |
| 1467862508 | Michelle Bistany | Counselor | 24647 North Milwaukee Avenue, Vernon Hills, IL 60061 | 2014-04-29 |
| 1740540913 | Serge Sorokin | Counselor | 565 Lakeview Parkway, Suite 105, Vernon Hills, IL 60061 | 2012-05-22 |
| 1972878304 | Valerie L Mayer | Counselor | 24647 N. Milwaukee Ave, Vernon Hills, IL 60061 | 2012-03-19 |
| 1407158033 | Ziemowit Mazur | Physician Assistant | 230 Center Drive, Vernon Hills, IL 60061 | 2010-12-02 |
| 1841508249 | Mandy L Imai | Speech-Language Pathologist | 200 N. Fairway Drive Ste 208, Vernon Hills, IL 60061 | 2010-09-20 |
| 1811203268 | Sarah E. Anderson | Occupational Therapist | 200 N. Fairway Drive, Suite 208, Vernon Hills, IL 60061 | 2010-08-24 |
| 1679898969 | Mussie Beraki | Internal Medicine | 6e Phillip Road Suite 1104, Vernon Hills, IL 60061 | 2010-03-30 |
| Find all providers in zip 60061 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932426863 | Lifeline Vascular Access Network, LLC | Radiology | Three Hawthorn Parkway, Suite 410, Vernon Hills, IL 60061-1450 | 2010-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588261978 | Thorek Radiology Group Nfp | Radiology | 850 West Irving Park Road, Chicago, IL 60613 | 2020-10-08 |
| 1659930998 | Howard Simon Md PC | Radiology | 446 E Ontario St Ste 106, Chicago, IL 60611-7110 | 2019-06-11 |
| 1982119319 | Vein and Vascular Centers, Sc | Radiology | 7 N Grant St Ste 1, Hinsdale, IL 60521-3366 | 2017-12-07 |
| 1114438769 | Advanced Midwest Interventional Radiology, LLC | Radiology | 1890 Silver Cross Blvd Ste 455, New Lenox, IL 60451-9546 | 2017-10-21 |
| 1528440690 | Tarek Jazmati | Radiology | 1653 W Congress Pkwy # 181, Chicago, IL 60612-3833 | 2015-06-24 |
| 1316351232 | Smg Billing, LLC | Radiology | 1105 S. Western Ave., Chicago, IL 60612 | 2014-06-18 |
| 1013270982 | Sean David Pietrini | Radiology | 1500 W Monroe St, Apartment 118, Chicago, IL 60607 | 2012-06-16 |
| 1417240102 | Sameul Hanif | Radiology | 7808 W College Dr Ste 1se, Palos Heights, IL 60463-1095 | 2011-05-27 |
| 1649563842 | Alex Edward Heaton | Radiology | 911 N Elm St Ste 128, Hinsdale, IL 60521-3640 | 2011-05-20 |
| 1063649093 | Sreekumar Madassery | Radiology | 1725 W. Congress Parkway, Ste 450, Chicago, IL 60612 | 2009-06-17 |
| Find all providers with the same taxonomy | ||||
| City | VERNON HILLS |
| Zip Code | 60061 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.