Healthcare Provider Details

I. General information

NPI: 1962313676
Provider Name (Legal Business Name): THE PHYSICIANS ON US GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE UNIT 3541
CHICAGO IL
60602-1903
US

IV. Provider business mailing address

111 N WABASH AVE UNIT 3541
CHICAGO IL
60602-1903
US

V. Phone/Fax

Practice location:
  • Phone: 312-409-0417
  • Fax: 276-777-7708
Mailing address:
  • Phone: 312-409-0417
  • Fax: 276-777-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT JAMES EDWARDS SR.
Title or Position: PRESIDENT & PRACTITIONER
Credential: PRACTITIONER
Phone: 312-409-0417