Berwyn Emergency Services SC

Primary specialty

SpecialistTaxonomy code 174400000X

License

036046173 Issued in IL

Legal business name

BERWYN EMERGENCY SERVICES SC

Practice address

3635 Harlem Ave
Berwyn, IL 60402-3212

Phone

(708) 447-9402

Fax

(708) 447-3246

NPI assigned

Nov 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Manohar L Jethani, MD

Title

Owner

Phone

(708) 447-9402

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Healthstop Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1184701328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 HARLEM AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023212",
            "telephone_number": "708-447-9402",
            "fax_number": "708-447-3246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3635 HARLEM AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023212",
            "telephone_number": "708-447-9402",
            "fax_number": "708-447-3246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERWYN EMERGENCY SERVICES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "JETHANI",
        "authorized_official_first_name": "MANOHAR",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-447-9402",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036046173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "01616688",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthstop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.