MEDICARE: EXCEPTIONAL HEALTH PARTNERS S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207Q00000X	Family Medicine Physician	IL
2	208000000X	Pediatrics Physician	IL
3	207R00000X	Internal Medicine Physician	IL

General Provider Information

NPI Number	:	1477741452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL HEALTH PARTNERS S.C.

Provider Business Mailing Address
First Line	:	PO BOX 306
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-0306
Country	:	US
Telephone Number	:	815-937-2044
Fax Number	:	815-937-2029

Provider Business Practice Location Address
First Line	:	13043 S.E. 2260 RD
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954
Country	:	US
Telephone Number	:	815-944-5410
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	MRS. ANNETTE WELLS
Credential	:
Telephone Number	:	815-937-2044

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/27/2007

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