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Rita Vida Odegaard

Radiology

Allopathic & Osteopathic Physicians

2160 South First Avenue, Maywood, IL 60153

PECOS Enrollment

This provider is enrolled in PECOS as RITA ODEGAARD.

Based on the most recent information from CMS, provider Rita Vida Odegaard is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 7 days ago.

Profile Details

Provider ID
1811927361
Provider Type
Individual
Full Name
Odegaard, Rita Vida
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
7/3/2006
Last Updated
3/31/2015

Contact Information

Practice Location

2160 South First Avenue, Maywood, IL 60153

(708) 216-3926

Unlisted Fax

Mailing Location

3756 King Williams Ct, St Charles, IL 60174-7806

(630) 762-8834

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 036-089815 Illinois

Provider Identifiers

ID	Description	Issuer
ID L62699	Description Other	Issuer PIN Illinois

Rita Vida Odegaard

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Zaleski, George X

Brooks, Cynthia K

Allam, Emad

Fu, John

Bova, Davide

Olson, Mary

Heller, Daniel Blake

Chu, Stanley Hoyin

Dudiak, Christine

Ward, Kathleen A