1811185770 NPI number — RHMOELLERENTERPRISES

Table of content: (NPI 1811185770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811185770 NPI number — RHMOELLERENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHMOELLERENTERPRISES
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:
1811185770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 OAKBROOK CTR
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-573-0360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OAKBROOK CTR
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-573-0360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOELLER
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-573-0360

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: K19185 . This is a "PIN#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2201654 . This is a "BLUE CROSS, BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com