Provider Demographics
NPI:1609827344
Name:ICARDIA HEALTHCARE CORP.
Entity Type:Organization
Organization Name:ICARDIA HEALTHCARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-207-1030
Mailing Address - Street 1:935 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 198
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:224-207-1030
Mailing Address - Fax:866-604-8037
Practice Address - Street 1:935 LAKEVIEW PARKWAY
Practice Address - Street 2:SUITE 198
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:224-207-1030
Practice Address - Fax:866-604-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211377Medicare ID - Type UnspecifiedMEDICARE PART B