MEDICARE: ALLIANCE OF CHICAGO THERAPEUTIC SERVICES AND SUPPLIES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1659603009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE OF CHICAGO THERAPEUTIC SERVICES AND SUPPLIES

Provider Business Mailing Address
First Line	:	2800 W PETERSON AVE
Second Line	:	SUITE 205
City	:	CHICAGO
State	:	IL
Zip	:	60659-3816
Country	:	US
Telephone Number	:	773-661-4499
Fax Number	:	773-290-1344

Provider Business Practice Location Address
First Line	:	2800 W PETERSON AVE
Second Line	:	SUITE 205
City	:	CHICAGO
State	:	IL
Zip	:	60659-3816
Country	:	US
Telephone Number	:	773-661-4499
Fax Number	:	773-290-1344

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CARTER MARTIN
Credential	:
Telephone Number	:	773-425-7977

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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