Basic Information
| Provider Information | |||||||||
| NPI: | 1720267008 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EDWARD HEALTH VENTURES | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AFTER HOURS CLINIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27555 DIEHL RD. | ||||||||
| Address2: | ENTRANCE B | ||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306463884 | ||||||||
| FaxNumber: | 6305480276 | ||||||||
| Practice Location | |||||||||
| Address1: | 2007 95TH ST. | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305277780 | ||||||||
| FaxNumber: | 6305277799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2007 | ||||||||
| LastUpdateDate: | 07/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | TADEY | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6306463884 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.