1134164213 NPI number — ADVENTIST HEALTH PARTNERS, INC

Table of content: (NPI 1134164213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134164213 NPI number — ADVENTIST HEALTH PARTNERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH PARTNERS, INC
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:
RICHARD J. CARROLL, MD
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:
1134164213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 QUAIL RIDGE DR
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:
60559-7009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-245-8071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 QUAIL RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-6145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-245-8071
Provider Business Practice Location Address Fax Number:
708-245-5642
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANN
Authorized Official First Name:
RUBY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
630-856-6884

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 399690 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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