1124422142 NPI number — ATHLETICO LTD

Table of content: ELIZABETH JANE SCHERER DPT (NPI 1750696936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124422142 NPI number — ATHLETICO LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHLETICO 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:
Provider Other Organization Name Type Code:
6
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:
1124422142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 OAKMONT LN STE 600C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-1980
Provider Business Mailing Address Fax Number:
630-928-5080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 LAUREL ST
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50314-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-231-7710
Provider Business Practice Location Address Fax Number:
515-244-9914
Provider Enumeration Date:
10/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GRANADOS
Authorized Official First Name:
JUANA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTAILING MANAGER
Authorized Official Telephone Number:
630-575-1980

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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