1417986357 NPI number — ORBIT MEDICAL OF NAPERVILLE LLC

Table of content: (NPI 1417986357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417986357 NPI number — ORBIT MEDICAL OF NAPERVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORBIT MEDICAL OF NAPERVILLE LLC
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:
ORBIT MEDICAL OF NAPERVILLE INC
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:
1417986357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9495 WINNETKA AVE N STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55445-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
629-252-8211
Provider Business Mailing Address Fax Number:
763-255-3972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 N COMMONS DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-8172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-544-5381
Provider Business Practice Location Address Fax Number:
630-544-5382
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
KILEY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF PAYOR RELATIONS
Authorized Official Telephone Number:
629-252-8211

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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