MEDICARE: ADVENTIST HEALTH PARTNERS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1427319144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTIST HEALTH PARTNERS, INC

Provider Business Mailing Address
First Line	:	1107 N PROSPECT AVE
Second Line	:	STE 100
City	:	ITASCA
State	:	IL
Zip	:	60143-1408
Country	:	US
Telephone Number	:	630-467-0101
Fax Number	:	630-467-0707

Provider Business Practice Location Address
First Line	:	1107 N PROSPECT AVE
Second Line	:	STE 100
City	:	ITASCA
State	:	IL
Zip	:	60143-1408
Country	:	US
Telephone Number	:	630-467-0101
Fax Number	:	630-467-0707

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. RUBY MANN
Credential	:
Telephone Number	:	630-856-6884

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	06/14/2017

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Directions to “ADVENTIST HEALTH PARTNERS, INC ” Practice Location

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