Healthcare Provider Details

I. General information

NPI: 1336353523
Provider Name (Legal Business Name): COMWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/23/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10257 STATE ROUTE THREE
RED BUD IL
62278
US

IV. Provider business mailing address

10257 STATE ROUTE 3 TRANSPORTATION
RED BUD IL
62278
US

V. Phone/Fax

Practice location:
  • Phone: 618-282-6233
  • Fax: 618-282-6949
Mailing address:
  • Phone: 618-282-6233
  • Fax: 618-282-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: AMY BAUER
Title or Position: IT COORDINATOR
Credential:
Phone: 618-282-6233