Provider Demographics
NPI:1427814029
Name:BUCKINGHAM PAVILION INC
Entity type:Organization
Organization Name:BUCKINGHAM PAVILION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPPER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZLATOPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-973-5333
Mailing Address - Street 1:2625 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2625 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3109
Practice Address - Country:US
Practice Address - Phone:773-973-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies