1407889652 NPI number — ADVENTIST MIDWEST HEALTH

Table of content: (NPI 1407889652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407889652 NPI number — ADVENTIST MIDWEST HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST MIDWEST HEALTH
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:
UCHICAGO MEDICINE ADVENTHEALTH LA GRANGE
Provider Other Organization Name Type Code:
3
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:
1407889652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5101 WILLOW SPRINGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60525-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-352-1200
Provider Business Mailing Address Fax Number:
630-312-7975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 WILLOW SPRINGS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60525-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-352-1200
Provider Business Practice Location Address Fax Number:
630-312-7975
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
CULLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
630-856-6062

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0005017 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 364257550001 . This is a "CHAMPUS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 399 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 140065 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 140065 . This is a "STERLING PLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 364257550001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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