1811012255 NPI number — EDWARD HEALTH VENTURES

Table of content: (NPI 1811012255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811012255 NPI number — EDWARD HEALTH VENTURES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD HEALTH VENTURES
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:
1811012255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27555 DIEHL RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-646-3950
Provider Business Mailing Address Fax Number:
630-548-6832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 SPALDING DRIVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-527-3788
Provider Business Practice Location Address Fax Number:
630-646-6071
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOTTMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-646-3950

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2221474 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com