MEDICARE: WSW HEALTH PARTNERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1033381017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSW HEALTH PARTNERS, LLC

Provider Business Mailing Address
First Line	:	3327 S GILES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3909
Country	:	US
Telephone Number	:	312-656-6163
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 S GILES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3909
Country	:	US
Telephone Number	:	312-656-6163
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MR. LARRY JENKINS
Credential	:
Telephone Number	:	312-953-0547

Provider Enumeration Date	:	03/30/2008
Last Update Date	:	03/30/2008

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