Provider Demographics
NPI:1073628046
Name:HINSDALE GASTROENTEROLOGY ASSOCIATES, SC
Entity type:Organization
Organization Name:HINSDALE GASTROENTEROLOGY ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-789-2260
Mailing Address - Street 1:12 SALT CREEK LN
Mailing Address - Street 2:SUITE 425
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8605
Mailing Address - Country:US
Mailing Address - Phone:630-789-2260
Mailing Address - Fax:630-789-8540
Practice Address - Street 1:12 SALT CREEK LN
Practice Address - Street 2:SUITE 425
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-8605
Practice Address - Country:US
Practice Address - Phone:630-789-2260
Practice Address - Fax:630-789-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL497360Medicare ID - Type UnspecifiedGROUP ID