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General NPI Number Information
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NPI Number | 1386415313
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Entity Type | Organization
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Legal Business Name | HOME CLINIX ILLINOIS LLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 259 E RAND RD STE 209B
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City | MT PROSPECT
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State | IL
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Zip | 60056-2184
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Country | US
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Telephone | 708-274-7322
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Fax | 801-890-3434
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Provider Business Mailing Address
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Address Line | 4337 W OXFORD ST
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City | CEDAR HILLS
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State | UT
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Zip | 84062-8638
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Country | US
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Telephone | 708-274-7322
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SPENCER CLARK
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Credential |
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Telephone | 708-274-7322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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