Organization
CENTRAD HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIDGETT ANN CALLAGHAN (VP, REIMBURSEMENT)
(630) 369-5840
Entity
Organization
Contact information
Practice address
419 N FENWAY ST, CASPER, WY 82601-2134
(307) 266-4434
(307) 266-4454
Mailing address
184 SHUMAN BLVD, SUITE 130, NAPERVILLE, IL 60563-1219
(630) 369-5840
(630) 369-5436
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
203000502
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
2389
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115544000
—
WY
05
—
115544001
—
WY
Enumeration date
12/04/2006
Last updated
04/07/2009
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