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General NPI Number Information
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NPI Number | 1518322817
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND'S MEDICAL SERVICES ORGANIZATION
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 4415 HARRISON ST STE 300
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City | HILLSIDE
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State | IL
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Zip | 60162-1953
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Country | US
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Telephone | 773-868-2030
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Fax | 888-972-1803
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Provider Business Mailing Address
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Address Line | 4415 HARRISON ST STE 300
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City | HILLSIDE
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State | IL
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Zip | 60162-1953
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Country | US
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Telephone | 773-868-2030
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Fax | 888-972-1803
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. DAMON V MORSE
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Credential |
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Telephone | 773-868-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | IL
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