Provider Demographics
NPI:1043297401
Name:INSIGHT CHICAGO, INC.
Entity type:Organization
Organization Name:INSIGHT CHICAGO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-275-9333
Mailing Address - Street 1:PO BOX 776473
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6473
Mailing Address - Country:US
Mailing Address - Phone:312-567-2000
Mailing Address - Fax:312-638-8320
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2000
Practice Address - Fax:312-567-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL362170152273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11727OtherCITY OF CHICAGO
IL362170152004Medicaid
IL362170152001Medicaid
IL006247OtherSTATE OF ILLINOIS LICENSE
IL00035OtherBCBSIL
IL=========004Medicaid