1811055056 NPI number — BILSTROM PAIN AND HEALTH SERVICES LLC

Table of content: ANDREA LYNN BODE VANN MS RD LD (NPI 1821328899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811055056 NPI number — BILSTROM PAIN AND HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILSTROM PAIN AND HEALTH SERVICES LLC
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:
1811055056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E OGDEN AVE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60521-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-325-2880
Provider Business Mailing Address Fax Number:
630-325-2890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E OGDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60521-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-325-2880
Provider Business Practice Location Address Fax Number:
630-325-2890
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BILSTROM
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN AND OWNER
Authorized Official Telephone Number:
630-325-2880

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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