MEDICARE: BENEDICTINE UNIVERSITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1710456199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEDICTINE UNIVERSITY

Provider Business Mailing Address
First Line	:	5700 COLLEGE RD
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-0900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 COLLEGE RD
Second Line	:
City	:	LISLE
State	:	IL
Zip	:	60532-0900
Country	:	US
Telephone Number	:	630-829-6154
Fax Number	:

Authorized Official
Title or Position	:	ATHLETIC DIRECTOR
Name	:	MARK MCHORNEY
Credential	:
Telephone Number	:	630-829-6150

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	11/15/2018

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Directions to “BENEDICTINE UNIVERSITY ” Practice Location

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