Provider Demographics
NPI:1376671685
Name:ELBURN HEALTH ASSOCIATES, S.C.
Entity type:Organization
Organization Name:ELBURN HEALTH ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-551-1097
Mailing Address - Street 1:905 N FIRST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-9155
Mailing Address - Country:US
Mailing Address - Phone:630-365-6891
Mailing Address - Fax:630-365-6911
Practice Address - Street 1:905 N FIRST ST
Practice Address - Street 2:SUITE A
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-9155
Practice Address - Country:US
Practice Address - Phone:630-365-6891
Practice Address - Fax:630-365-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202187Medicare PIN
ILC42235Medicare UPIN