Adventist Health Partners, Inc

Organization Active NPI Family Medicine Physician · Wood Dale, IL

NPI 1962632877 · NPPES record last updated Feb 19, 2013

Key facts

NPI
1962632877
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
ADVENTIST HEALTH PARTNERS, INC
Practice address
199 S Addison Rd
Suite 108
Wood Dale, IL 60191-1929
Phone
(630) 616-7223
Fax
(630) 616-7224
NPI assigned
Jul 27, 2009
Organization subpart
No

Authorized official

Name
Mrs. Ruby Mann
Title
Director
Phone
(630) 856-6889

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040127000064 IL Part B Supplier - Clinic/Group Practice 0244135762 Receives reassigned benefits from 392 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Locations

199 S Addison Rd
Ste 108
Wood Dale, IL 60191
Phone (630) 616-7223

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP
207Q00000X Yes

Addresses

Primary practice location

199 S Addison Rd
Suite 108
Wood Dale, IL 60191-1929

Mailing address

199 S Addison Rd
Ste 108
Wood Dale, IL 60191-1929
Phone (630) 616-7223

Other identifiers

IdentifierTypeStateIssuer
400480OtherILMEDICARE PTAN

Other names

  • WOOD DALE FAMILY MEDICINE Doing business as

Other providers in Wood Dale, IL

All providers in Wood Dale, IL · Family Medicine Physician in Illinois

Sources for this page

Verify at the official NPI Registry.