1124079249 NPI number — DR. JOHN D EDWARDS MD

Table of content: DR. JOHN D EDWARDS MD (NPI 1124079249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124079249 NPI number — DR. JOHN D EDWARDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDWARDS
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1124079249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 W CENTRAL RD STE 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-2355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-618-3800
Provider Business Mailing Address Fax Number:
847-618-3809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 W CENTRAL RD
Provider Second Line Business Practice Location Address:
SUITE 5000
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-618-3800
Provider Business Practice Location Address Fax Number:
847-618-3809
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  0101249785 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 35-072723 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 38823 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 036139185 , 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: 3709852000 . This is a "PASSPORT ADVTG - NVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64960628 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103475 . This is a "SIHO - NVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6286669 . This is a "CIGNA - NVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000609662 . This is a "ANTHEM - NVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200164020 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2040375 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50011792 . This is a "PASSPORT - NVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00201740 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00733104 . This is a "RR MCR-KY (NVA)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023035Y . This is a "HUMANA - CTS (NVA)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533123 . This is a "MEDICARE KY - CTS (NVA)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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