Healthcare Provider Details

I. General information

NPI: 1194108449
Provider Name (Legal Business Name): HS CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHASE CORPORATE DR SUITE 300
HOOVER AL
35244-1016
US

IV. Provider business mailing address

1340 S DAMEN AVE SUITE 400
CHICAGO IL
60608-1169
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax:
Mailing address:
  • Phone: 708-292-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIRK O WALES
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 615-564-3511