Provider Demographics
NPI:1528183589
Name:SUMMIT SCH DIST 104
Entity type:Organization
Organization Name:SUMMIT SCH DIST 104
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-458-0505
Mailing Address - Street 1:60TH STREET & 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501
Mailing Address - Country:US
Mailing Address - Phone:708-458-0505
Mailing Address - Fax:708-728-3111
Practice Address - Street 1:60TH STREET & 74TH AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501
Practice Address - Country:US
Practice Address - Phone:708-458-0505
Practice Address - Fax:708-728-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health