=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649672353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL SERVICES SA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2014
-----------------------------------------------------
Last Update Date | 06/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6307 S STEWART AVE STE 304
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60621-3116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-431-0411
-----------------------------------------------------
Fax | 844-431-0411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 E 87TH ST SUITE 1000
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-7011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-375-8188
-----------------------------------------------------
Fax | 773-375-8188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEORGES B GERMAIN SR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 773-375-8188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------