Provider Demographics
NPI:1225391022
Name:ADVENTIST HEALTH PARTNERS, INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS, INC
Other - Org Name:MIDWEST CONCUSSION & SPORTS MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:630-312-7865
Mailing Address - Street 1:329 REMINGTON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5827
Mailing Address - Country:US
Mailing Address - Phone:630-312-6161
Mailing Address - Fax:
Practice Address - Street 1:329 REMINGTON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5827
Practice Address - Country:US
Practice Address - Phone:630-312-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty