NPIMap

Organization Active NPI

Ageless Men's Health Holdings Inc

Doing business as Ageless Men's Health

  • Family Medicine Physician
  • Mokena, IL
National Provider Identifier
1194460154
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AGELESS MEN'S HEALTH HOLDINGS INC
Doing business as
Ageless Men's Health
Practice address
10074 W 190TH PL Ste 10074
Mokena, IL 60448-8752
Phone
(630) 317-7690
NPI assigned
May 3, 2022
Last updated
Nov 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
Amanda Wilkinson
Title
Business Operations Director
Phone
(702) 818-0446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

10074 W 190TH PL Ste 10074
Mokena, IL 60448-8752

Mailing address

10074 W 190TH PL Ste 10074
Mokena, IL 60448-8752

Other names 1

  • Ageless Men's Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ageless Men's Health Holdings LLC18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

10030 W 190th Pl
Mokena, IL 60448

10074 W 190th Pl
Ste 10074
Mokena, IL 60448
Phone (630) 317-7690

NPI Registry JSON

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

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1194460154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10074 W 190TH PL STE 10074",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10074 W 190TH PL STE 10074",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488752",
            "telephone_number": "630-317-7690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS MEN'S HEALTH HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-03",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "702-818-0446"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageless Men's Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ageless Men's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.