Basic Information
| Provider Information | |||||||||
| NPI: | 1679518765 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST HEALTH PARTNERS,INC | ||||||||
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| OtherOrganizationName: | ADVENTIST MIDWEST GERATRICS SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7009 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604407009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303127865 | ||||||||
| FaxNumber: | 6303127902 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082454073 | ||||||||
| FaxNumber: | 7082455614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | MANN | ||||||||
| AuthorizedOfficialFirstName: | RUBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 63085668844 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.