Provider Demographics
NPI:1821288945
Name:EXCEPTIONAL HEALTH PARTNERS, S.C.
Entity Type:Organization
Organization Name:EXCEPTIONAL HEALTH PARTNERS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-937-2044
Mailing Address - Street 1:401 N WALL ST
Mailing Address - Street 2:STE 206
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2934
Mailing Address - Country:US
Mailing Address - Phone:815-937-2044
Mailing Address - Fax:815-937-2029
Practice Address - Street 1:401 N WALL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2934
Practice Address - Country:US
Practice Address - Phone:815-937-2044
Practice Address - Fax:815-937-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068108207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD16438Medicare UPIN