Provider Demographics
NPI:1528136728
Name:CENTRAD HEALTHCARE LLC
Entity type:Organization
Organization Name:CENTRAD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GIDGETT
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CALLAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-369-5840
Mailing Address - Street 1:184 SHUMAN BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1219
Mailing Address - Country:US
Mailing Address - Phone:630-369-5840
Mailing Address - Fax:630-369-5436
Practice Address - Street 1:419 N FENWAY ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2134
Practice Address - Country:US
Practice Address - Phone:307-266-4434
Practice Address - Fax:307-266-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2389332BX2000X
IL203000502332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115544000Medicaid
WY115544001Medicaid
WY115544001Medicaid