Provider Demographics
NPI:1366487704
Name:ADVENTIST HEALTH PARTNERS,INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS,INC
Other - Org Name:CONSULTING SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6884
Mailing Address - Street 1:5201 S WILLOW SPRINGS
Mailing Address - Street 2:STE 290
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-579-0018
Mailing Address - Fax:708-579-7571
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:STE 290
Practice Address - City:LAGRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-579-0018
Practice Address - Fax:708-579-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL403270Medicare ID - Type Unspecified