1164426821 NPI number — DREHER ORTHOPEDIC INDUSTRIES, INC.

Table of content: (NPI 1164426821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164426821 NPI number — DREHER ORTHOPEDIC INDUSTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DREHER ORTHOPEDIC INDUSTRIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164426821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 CHICAGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-848-4646
Provider Business Mailing Address Fax Number:
708-848-1341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 CHICAGO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-848-4646
Provider Business Practice Location Address Fax Number:
708-848-1341
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DREHER
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
708-848-4646

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01670372 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0570184 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64126 . This is a "AMERIGROUP INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81297200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56800 . This is a "NORTHWOOD INS PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 854565584 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200088770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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