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General NPI Number Information
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NPI Number | 1710296603
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Entity Type | Organization
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Legal Business Name | AMERICAN HOSPITAL SERVICE CORPORATION
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 6157 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4004
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Country | US
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Telephone | 773-745-8434
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Fax | 773-745-3443
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Provider Business Mailing Address
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Address Line | 6157 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4004
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Country | US
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Telephone | 773-745-8434
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Fax | 773-745-3443
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HENRYK J ROZTOCZYNSKI
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Credential | MD, PHD
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Telephone | 773-745-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036058369
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License Number State | IL
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