Healthcare Provider Details

I. General information

NPI: 1053415653
Provider Name (Legal Business Name): ADVENTIST MIDWEST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NORTH OAK STREET
HINSDALE IL
60521-3829
US

IV. Provider business mailing address

120 NORTH OAK STREET
HINSDALE IL
60521-3829
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-3966
  • Fax: 630-856-3939
Mailing address:
  • Phone: 630-856-3966
  • Fax: 630-856-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number093002925
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE THOMAS
Title or Position: DIRECTOR REIMBURSEMENT
Credential:
Phone: 407-357-2315