1801844642 NPI number — OAD ORTHOPAEDICS, LTD

Table of content: (NPI 1801844642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801844642 NPI number — OAD ORTHOPAEDICS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAD ORTHOPAEDICS, LTD
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:
ORTHOPAEDIC ASSOCIATES OF DUPAGE, LTD
Provider Other Organization Name Type Code:
4
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:
1801844642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27650 FERRY RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-225-2663
Provider Business Mailing Address Fax Number:
630-225-2399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27650 FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WARRENVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60555-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-225-2663
Provider Business Practice Location Address Fax Number:
630-225-2399
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRAUKLIS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
630-225-2663

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206229 . This is a "MEDICARE GRP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02201368 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 204398 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 206224 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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