Provider Demographics
NPI:1740489897
Name:ADVANCED HEALTH SC
Entity type:Organization
Organization Name:ADVANCED HEALTH SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-941-8190
Mailing Address - Street 1:401 N YORK ST
Mailing Address - Street 2:STE 4
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5510
Mailing Address - Country:US
Mailing Address - Phone:630-941-8190
Mailing Address - Fax:630-941-8194
Practice Address - Street 1:401 N YORK ST
Practice Address - Street 2:STE 4
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5510
Practice Address - Country:US
Practice Address - Phone:630-941-8190
Practice Address - Fax:630-941-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008756111N00000X, 247200000X
IL036-126661202K00000X
IL036-119654207Q00000X
225100000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU80400Medicare UPIN
IL584120Medicare PIN
IL6207110001Medicare NSC