Bella Medica Laser Center

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

NA Issued in IL

Legal business name

BELLA MEDICA LASER CENTER

Practice address

5435 Bull Valley Rd
Suite#118
McHenry, IL 60050-7434

Phone

(815) 344-0303

NPI assigned

Sep 8, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Travis Jay Rader, CLT

Title

Dir. of Operations

Phone

(815) 344-0303

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315440000000",
    "number": "1255612933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 BULL VALLEY RD",
            "address_2": "SUITE#118",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507434",
            "telephone_number": "815-344-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5435 BULL VALLEY RD",
            "address_2": "SUITE#118",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507434",
            "telephone_number": "815-344-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLA MEDICA LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-08",
        "last_updated": "2011-09-08",
        "status": "A",
        "authorized_official_last_name": "RADER",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "DIR. OF OPERATIONS",
        "authorized_official_telephone_number": "815-344-0303",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CLT"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": "IL",
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Other Specialist/Technologist in McHenry, IL
• Providers in McHenry, IL by specialty
• Other Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; 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.