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NPI Code Detail

MEDICARE: PRESENCE AMBULATORY SERVICES

MEDICARE: PRESENCE AMBULATORY SERVICES
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1114253812
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESENCE AMBULATORY SERVICES
Provider Business Mailing Address
First Line : 1000 REMINGTON BLVD
Second Line : SUITE 100
City : BOLINGBROOK
State : IL
Zip : 60440-0000
Country : US
Telephone Number : 630-914-2417
Fax Number : 630-914-2499
Provider Business Practice Location Address
First Line : 4900 N CUMBERLAND AVE
Second Line :
City : NORRIDGE
State : IL
Zip : 60706-2916
Country : US
Telephone Number : 708-456-1600
Fax Number : 708-463-2781
Authorized Official
Title or Position : CREDENTIALING MGR
Name : MRS. MELVONNE WICKLIFFE-JONES
Credential :
Telephone Number : 630-914-2417
Provider Enumeration Date : 10/30/2009
Last Update Date : 05/29/2013

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Directions to “PRESENCE AMBULATORY SERVICES ” Practice Location

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