Brookstone of Emerald Glen of Olney, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

BROOKSTONE OF EMERALD GLEN OF OLNEY, LLC

Practice address

1301 N East St
Olney, IL 62450-2430

Phone

(618) 395-4663

Fax

(618) 392-6313

NPI assigned

Oct 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. John Holtz

Title

Controller

Phone

(541) 747-3373

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1326299587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 CENTENNIAL LOOP",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974017900",
            "telephone_number": "541-747-3373",
            "fax_number": "541-868-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N EAST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502430",
            "telephone_number": "618-395-4663",
            "fax_number": "618-392-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSTONE OF EMERALD GLEN OF OLNEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "541-747-3373",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brad McMillin, Inc
• Bradley Houston M.D.
• Bridgeance Corp
• Herbert Herman Brokhof, D.D.S.
• Brookstone Estates of Olney
• Daniel Joseph Brown, OD
• Madison Bruce, BSW
• Amanda Jo Buerster
• Rebecca Buffington
• Jamie K Bump, NP-C

• Point of Service in Olney, IL
• Providers in Olney, IL by specialty
• Point of Service in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.