Healthcare Provider Details

I. General information

NPI: 1740489897
Provider Name (Legal Business Name): ADVANCED HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N YORK ST STE 4
ELMHURST IL
60126-5510
US

IV. Provider business mailing address

401 N YORK ST STE 4
ELMHURST IL
60126-5510
US

V. Phone/Fax

Practice location:
  • Phone: 630-941-8190
  • Fax: 630-941-8194
Mailing address:
  • Phone: 630-941-8190
  • Fax: 630-941-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008756
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036-126661
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-119654
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number038-008756
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUG H. SIMPER
Title or Position: PHYSICIAN
Credential: D.C.
Phone: 630-941-8190