Healthcare Provider Details

I. General information

NPI: 1083966378
Provider Name (Legal Business Name): ADVENTIST HEALTH PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15724 S ROUTE 59 SUITE 102
PLAINFIELD IL
60544-2795
US

IV. Provider business mailing address

15724 S ROUTE 59 SUITE 102
PLAINFIELD IL
60544-2795
US

V. Phone/Fax

Practice location:
  • Phone: 630-312-3330
  • Fax: 815-267-7644
Mailing address:
  • Phone: 630-312-3330
  • Fax: 815-267-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. RUBY MANN
Title or Position: DIRECTOR
Credential:
Phone: 630-856-6884