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General NPI Number Information
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NPI Number | 1033162086
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Entity Type | Organization
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Legal Business Name | LITTLE COMPANY OF MARY AFFILIATED SERVICES INC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 5660 W 95TH ST SUITE 1
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City | OAK LAWN
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State | IL
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Zip | 60453-2380
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Country | US
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Telephone | 708-499-2273
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Fax | 708-857-4435
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Provider Business Mailing Address
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Address Line | 5660 W 95TH ST SUITE 1
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City | OAK LAWN
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State | IL
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Zip | 60453-2380
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Country | US
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Telephone | 708-499-2273
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Fax | 708-857-4435
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Authorized Official
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Title or Position | DIRECTOR, PROFESSIONAL SERVICES
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Name | CAROL A HEENAN
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Credential |
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Telephone | 708-229-5171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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