Individual ProviderTheodore BanksEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address4201 W Medical Center Dr, Mchenry, IL 60050(815) 338-6600PECOS EnrollmentBased on the most recent information from CMS, provider Theodore Banks is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1790723500Provider TypeIndividualFull NameBanks, TheodoreTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date6/3/2006Last Updated3/7/2023Contact InformationPractice LocationPractice Address4201 W Medical Center Dr, Mchenry, IL 60050Phone(815) 338-6600FaxUnlisted FaxMailing LocationMailing Address4201 W Medical Center Dr, Mchenry, IL 60050-8409Phone(815) 338-6600FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense036123608IllinoisCode207P00000XDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense01049408AIndianaProvider IdentifiersIDDescriptionIssuerID01049408ADescriptionOtherIssuerINDIANA LICENSEIndianaID200197460DescriptionMedicaidIssuerUnlistedIndianaID036123608DescriptionOtherIssuerSTATE LICENSEIllinoisID01049408BDescriptionOtherIssuerCSRIndiana