Provider Demographics
NPI:1306933262
Name:VICENTE S. ZATA, M.D.,P.C.
Entity type:Organization
Organization Name:VICENTE S. ZATA, M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PCP
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETH
Authorized Official - Middle Name:CONCEPCION
Authorized Official - Last Name:JACINTO-ZATA
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:618-576-2416
Mailing Address - Street 1:2 MYRTLE LANE
Mailing Address - Street 2:P.O BOX 310
Mailing Address - City:HARDIN
Mailing Address - State:IL
Mailing Address - Zip Code:62047-0310
Mailing Address - Country:US
Mailing Address - Phone:618-576-2416
Mailing Address - Fax:618-576-9298
Practice Address - Street 1:2 MYRTLE LANE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:IL
Practice Address - Zip Code:62047-0310
Practice Address - Country:US
Practice Address - Phone:618-576-2416
Practice Address - Fax:618-576-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000715000OtherBCBS
IL036051832Medicaid
IL215775Medicare PIN
215775Medicare PIN
IL036051832Medicaid