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General NPI Number Information
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NPI Number | 1144686676
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Entity Type | Organization
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Legal Business Name | FLAWLESS SERVICE CORPORATION
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 1272 WINSTON PLZ MELROSE PARK CLINIC
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City | MELROSE PARK
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State | IL
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Zip | 60160-1507
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Country | US
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Telephone | 708-615-7546
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 804193
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City | CHICAGO
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State | IL
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Zip | 60680-4103
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Country | US
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Telephone | 312-222-0030
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/SURGEON
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Name | DR. ELTON XAVIER TINLEY
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Credential |
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Telephone | 312-222-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 036079325
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License Number State | IL
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