Provider Demographics
NPI:1760182307
Name:AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-666-0602
Mailing Address - Street 1:1261 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-5586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1261 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-5586
Practice Address - Country:US
Practice Address - Phone:818-666-0602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTHCARE SYSTEMS ILLINOIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center