1205913308 NPI number — ADVENT NEUROLOGY SC

Table of content: (NPI 1205913308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205913308 NPI number — ADVENT NEUROLOGY SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENT NEUROLOGY SC
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:
1205913308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
657 E GOLF RD
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-4968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-640-7377
Provider Business Mailing Address Fax Number:
847-640-7977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
657 E GOLF RD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-640-7377
Provider Business Practice Location Address Fax Number:
847-640-7977
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARAMREDDY
Authorized Official First Name:
SAILAJA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-640-7377

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DC1155 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01634570 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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