Provider Demographics
NPI:1588609184
Name:ADVENTIST HEALTH PARTNERS,INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH PARTNERS,INC
Other - Org Name:CLARENDON HILLS FAMILY MEDICINE
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 1:99 PARK AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1492
Mailing Address - Country:US
Mailing Address - Phone:630-455-7000
Mailing Address - Fax:630-455-7001
Practice Address - Street 1:99 PARK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1492
Practice Address - Country:US
Practice Address - Phone:630-455-7000
Practice Address - Fax:630-455-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399690Medicare ID - Type Unspecified