1477982767 NPI number — EDWARD HEALTH VENTURES

Table of content: (NPI 1477982767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477982767 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:
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:
1477982767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2013
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:
ENTRANCE B
Provider Business Mailing Address City Name:
WARRENVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60555-3849
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:
1222 N EOLA RD
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:
60502-9409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-646-6250
Provider Business Practice Location Address Fax Number:
630-236-2363
Provider Enumeration Date:
11/06/2013

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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