Healthcare Provider Details

I. General information

NPI: 1003177320
Provider Name (Legal Business Name): MEDICAL ACCESS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 W ROOSEVELT RD SUITE 224
WESTCHESTER IL
60154-2664
US

IV. Provider business mailing address

10001 W ROOSEVELT RD SUITE 224
WESTCHESTER IL
60154-2664
US

V. Phone/Fax

Practice location:
  • Phone: 708-356-4300
  • Fax: 708-356-4301
Mailing address:
  • Phone: 708-356-4300
  • Fax: 708-356-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VELMA SMITH
Title or Position: MANAGER
Credential:
Phone: 708-356-4300