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General NPI Number Information
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NPI Number | 1801171277
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Entity Type | Organization
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Legal Business Name | MED STAFF ON-CALL
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 1332 N HALSTED ST SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60642-2624
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Country | US
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Telephone | 888-270-8374
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Fax | 888-288-7102
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Provider Business Mailing Address
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Address Line | 1332 N HALSTED ST SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60642-2624
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Country | US
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Telephone | 888-270-8374
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Fax | 888-288-7102
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Authorized Official
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Title or Position | CEO
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Name | DR. DENISE A KENT
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Credential | PHD, APN, RN
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Telephone | 888-270-8374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 2011-N1142
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License Number State | IL
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