MEDICARE: RESURRECTION AMBULATORY SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QR0200X	Radiology Clinic/Center
3	261QR0206X	Mammography Clinic/Center
4	261QR0404X	Cardiac Rehabilitation Clinic/Center
5	207R00000X	Internal Medicine Physician
6	207RC0000X	Cardiovascular Disease Physician
7	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
8	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1588991368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURRECTION AMBULATORY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 6670
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-6670
Country	:	US
Telephone Number	:	708-675-8160
Fax Number	:	708-364-7474

Provider Business Practice Location Address
First Line	:	2433 N HARLEM AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60707-2031
Country	:	US
Telephone Number	:	773-889-6355
Fax Number	:	773-355-2815

Authorized Official
Title or Position	:	SYSTEM DIRECTOR
Name	:	DEAN M. HOBSON
Credential	:
Telephone Number	:	773-797-3603

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	03/15/2010

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Directions to “RESURRECTION AMBULATORY SERVICES ” Practice Location

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