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NPI Code Detail

MEDICARE: THE RENAISSANCE PARK SOUTH, LLC

MEDICARE: THE RENAISSANCE PARK SOUTH, 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
1332BX2000XOxygen Equipment & Supplies (DME)0049098IL

General Provider Information

NPI Number : 1255622023
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE RENAISSANCE PARK SOUTH, LLC
Provider Business Mailing Address
First Line : 7257 N LINCOLN AVE
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-1810
Country : US
Telephone Number : 847-933-2600
Fax Number :
Provider Business Practice Location Address
First Line : 10935 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3127
Country : US
Telephone Number : 773-928-2000
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF RESIDENT ACCT & BILLING
Name : EMILY KOPSIAS
Credential :
Telephone Number : 847-745-6226
Provider Enumeration Date : 04/27/2011
Last Update Date : 04/27/2011

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Directions to “THE RENAISSANCE PARK SOUTH, LLC ” Practice Location

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