Healthcare Provider Details

I. General information

NPI: 1306290002
Provider Name (Legal Business Name): MEDICALWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 S RANDALL RD 124
GENEVA IL
60134-4646
US

IV. Provider business mailing address

1770 S RANDALL RD 124
GENEVA IL
60134-4646
US

V. Phone/Fax

Practice location:
  • Phone: 203-689-6757
  • Fax: 844-688-4264
Mailing address:
  • Phone: 203-689-6757
  • Fax: 844-688-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY CHARLES L BEHRENDT III
Title or Position: OWNER
Credential: MBA
Phone: 203-689-6757