Healthcare Provider Details

I. General information

NPI: 1770283301
Provider Name (Legal Business Name): AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 HAMACHER ST STE 300
WATERLOO IL
62298-1592
US

IV. Provider business mailing address

509 HAMACHER ST STE 300
WATERLOO IL
62298-1592
US

V. Phone/Fax

Practice location:
  • Phone: 818-666-0602
  • Fax:
Mailing address:
  • Phone: 618-393-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BURKET
Title or Position: CORPORATE COMPLIANCE
Credential:
Phone: 818-666-0602