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General NPI Number Information
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NPI Number | 1801476502
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Entity Type | Organization
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Legal Business Name | PRESTIGE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 8800 W 159TH ST
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City | ORLAND PARK
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State | IL
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Zip | 60462-5618
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Country | US
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Telephone | 708-942-6843
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N VINE ST UNIT 614
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City | NEW LENOX
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State | IL
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Zip | 60451-5032
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Country | US
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Telephone | 708-942-6843
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANNA SKOBEL
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Credential |
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Telephone | 708-942-6843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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