MEDICARE: HEALTH SERVICES NETWORK, INC.

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	343900000X	Non-emergency Medical Transport (VAN)	69592597	IL

General Provider Information

NPI Number	:	1083015671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH SERVICES NETWORK, INC.

Provider Business Mailing Address
First Line	:	8018 S DANTE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-4621
Country	:	US
Telephone Number	:	773-437-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	8018 S DANTE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-4621
Country	:	US
Telephone Number	:	773-437-3166
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KARIN CARMICHAEL
Credential	:
Telephone Number	:	773-437-3166

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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