Provider Demographics
NPI:1508350729
Name:HAYS, AARON (CPO)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:HAYS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1918
Mailing Address - Country:US
Mailing Address - Phone:815-401-7260
Mailing Address - Fax:
Practice Address - Street 1:453 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1918
Practice Address - Country:US
Practice Address - Phone:815-401-7260
Practice Address - Fax:815-401-7267
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000210222Z00000X
IL211.000202224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL472042181001Medicaid