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General NPI Number Information
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NPI Number | 1306290002
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Entity Type | Organization
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Legal Business Name | MEDICALWORKS LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 1770 S RANDALL RD 124
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City | GENEVA
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State | IL
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Zip | 60134-4646
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Country | US
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Telephone | 203-689-6757
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Fax | 844-688-4264
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Provider Business Mailing Address
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Address Line | 1770 S RANDALL RD 124
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City | GENEVA
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State | IL
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Zip | 60134-4646
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Country | US
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Telephone | 203-689-6757
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Fax | 844-688-4264
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Authorized Official
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Title or Position | OWNER
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Name | MR. HENRY CHARLES L BEHRENDT III
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Credential | MBA
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Telephone | 203-689-6757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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