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General NPI Number Information
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NPI Number | 1417460312
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Entity Type | Organization
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Legal Business Name | THARRIS APN LTD
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 2460 S EOLA RD
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City | AURORA
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State | IL
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Zip | 60503-6494
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Country | US
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Telephone | 630-585-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S MADISON ST
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City | OSWEGO
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State | IL
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Zip | 60543-9056
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIAL MANAGER
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Name | JAVIER BANUELOS
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Credential |
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Telephone | 630-649-3974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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