PAUL POTACH D.P.M., P.C. NPI 1003418823

Non-Pharmacy Dispensing Site in Berwyn, IL

NPI 1003418823 Organization Non-Pharmacy Dispensing Site

About PAUL POTACH D.P.M., P.C.

Paul Potach D.p.m.,p.c. is a provider established in Berwyn, Illinois specializing in non-pharmacy dispensing site. The NPI number of Paul Potach D.p.m.,p.c. is 1003418823 and was assigned on November 2020. The practitioner's primary taxonomy code is 332900000X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Dr. Paul Potach D.p.m. (Owner)

NPI

1003418823

Provider NamePAUL POTACH D.P.M.,P.C.
Provider Location Address3100 OAK PARK AVE BERWYN, IL 60402
Provider Mailing Address3100 SOUTH OAK PARK AVE BERWYN, IL 60402
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date11-16-2020
Last Update Date11-16-2020


Primary Taxonomy

Taxonomy Code332900000X
ClassificationNon-Pharmacy Dispensing Site
TypeSuppliers
Taxonomy DescriptionA site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

Business Address

PAUL POTACH D.P.M.,P.C.
3100 OAK PARK AVE
BERWYN, IL
ZIP 60402
Phone: (708) 484-3338
Fax: (708) 484-2059

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Mailing Address

PAUL POTACH D.P.M.,P.C.
3100 SOUTH OAK PARK AVE
BERWYN, IL
ZIP 60402
Phone: (708) 484-3338
Fax: (708) 484-2059



Authorized Official

Authorized Official NameDR. PAUL POTACH D.P.M.
Authorized Official TitleOWNER
Authorized Official Phone(708) 484-3338

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1205883840 ELINA HUDSON MD
Individual
Family Medicine3100 OAK PARK AVE BERWYN
BERWYN, IL 60402
(708) 788-1005
1730249673HUDSON MEDICAL CENTER LTD
Organization
Family Medicine3100 OAK PARK AVE
BERWYN, IL 60402
(708) 788-1005

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.