Healthcare Provider Details

I. General information

NPI: 1629210091
Provider Name (Legal Business Name): CHEVY CHASE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S INDIANA AVE
CHICAGO IL
60616-3841
US

IV. Provider business mailing address

7257 N LINCOLN AVE
LINCOLNWOOD IL
60712-1810
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-5000
  • Fax: 312-842-3790
Mailing address:
  • Phone: 847-933-2600
  • Fax: 847-933-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0040592
License Number StateIL

VIII. Authorized Official

Name: REUVEN LEVITIN
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 847-745-6240