Provider Demographics
NPI:1710938295
Name:EDWARD HEALTH VENTURES
Entity Type:Organization
Organization Name:EDWARD HEALTH VENTURES
Other - Org Name:LINDEN OAKS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-646-3950
Mailing Address - Street 1:3540 SEVEN BRIDGES DRIVE
Mailing Address - Street 2:STE 230
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1222
Mailing Address - Country:US
Mailing Address - Phone:630-964-9400
Mailing Address - Fax:630-964-9375
Practice Address - Street 1:3540 SEVEN BRIDGES DR
Practice Address - Street 2:STE 230
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1222
Practice Address - Country:US
Practice Address - Phone:630-964-9400
Practice Address - Fax:630-964-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047726 1Medicaid
IL2234315OtherBCBS
IL207953Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK48104Medicare PIN
IL036047726 1Medicaid
ILCC2969Medicare PIN