Provider Demographics
NPI:1568672061
Name:TRAUMA ONE,LLC
Entity Type:Organization
Organization Name:TRAUMA ONE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:NERBOVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-670-1002
Mailing Address - Street 1:SDS 12-2675
Mailing Address - Street 2:PO BOX 86
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0001
Mailing Address - Country:US
Mailing Address - Phone:630-670-1002
Mailing Address - Fax:952-216-0230
Practice Address - Street 1:2801 FINLEY RD
Practice Address - Street 2:STE 220
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1038
Practice Address - Country:US
Practice Address - Phone:630-670-1002
Practice Address - Fax:952-216-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILK13637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty