Provider Demographics
NPI:1104937168
Name:ANDSAR INC.
Entity type:Organization
Organization Name:ANDSAR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-584-0310
Mailing Address - Street 1:1605 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1657
Mailing Address - Country:US
Mailing Address - Phone:630-584-0310
Mailing Address - Fax:630-584-0354
Practice Address - Street 1:1605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1657
Practice Address - Country:US
Practice Address - Phone:630-584-0310
Practice Address - Fax:630-584-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1209100001Medicare ID - Type Unspecified
IL1209100002Medicare ID - Type Unspecified