Healthcare Provider Details

I. General information

NPI: 1396037578
Provider Name (Legal Business Name): TASC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N HALSTED ST
CHICAGO IL
60642-2517
US

IV. Provider business mailing address

1500 N HALSTED ST
CHICAGO IL
60642-2517
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-0802
  • Fax: 312-787-9663
Mailing address:
  • Phone: 312-787-0802
  • Fax: 312-787-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROY FESMIRE
Title or Position: CFO
Credential:
Phone: 312-573-8271