1457397317 NPI number — ADVENTIST MIDWEST HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457397317 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 HOME CARE
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:
1457397317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2023
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:
708-245-6901
Provider Business Mailing Address Fax Number:
708-245-6919

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:
708-245-6901
Provider Business Practice Location Address Fax Number:
708-245-6919
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEEBE
Authorized Official First Name:
HARMAT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
630-856-6001

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1693721 , 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: 9627 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363106866001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000397 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 147207 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 147207 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 147207 . This is a "SETERLIN GLIFE MCR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 147207 . This is a "HUMANA GOLD CHC MCR" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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