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General NPI Number Information
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NPI Number | 1033381017
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Entity Type | Organization
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Legal Business Name | WSW HEALTH PARTNERS, LLC
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Dates
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Enumeration Date | 03/30/2008
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Last Update Date | 03/30/2008
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Provider Practice Location Address
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Address Line | 3327 S GILES AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3909
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Country | US
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Telephone | 312-656-6163
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Fax |
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Provider Business Mailing Address
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Address Line | 3327 S GILES AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3909
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Country | US
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Telephone | 312-656-6163
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. LARRY JENKINS
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Credential |
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Telephone | 312-953-0547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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