Basic Information
| Provider Information | |||||||||
| NPI: | 1972757557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | MEAGAN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIBIKAWSKIS | ||||||||
| OtherFirstName: | MEAGAN | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2320 HIGH STREET | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | BLUE ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604062426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083885500 | ||||||||
| FaxNumber: | 7083885672 | ||||||||
| Practice Location | |||||||||
| Address1: | 17495 LA GRANGE RD | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604877581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082267000 | ||||||||
| FaxNumber: | 7083885672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2008 | ||||||||
| LastUpdateDate: | 09/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085003382 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | P00680761 | 01 | IL | RAILROAD MEDICARE | OTHER |