Healthcare Provider Details

I. General information

NPI: 1679512016
Provider Name (Legal Business Name): ILLINOIS/INDIANA EM-I MEDICAL SERVICES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

PO BOX 41494
PHILADELPHIA PA
19101-1494
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-7500
  • Fax: 773-947-7792
Mailing address:
  • Phone: 800-732-1066
  • Fax: 630-941-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS P. WEBSTER
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 800-732-1066