MEDICARE: ILLIANA HOME PHYSICIAN SERVICES 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1669938304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLIANA HOME PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	2100 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2153
Country	:	US
Telephone Number	:	708-933-0872
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2153
Country	:	US
Telephone Number	:	708-933-0872
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. JAMES EDWARD BECKETT
Credential	:
Telephone Number	:	708-341-6707

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/19/2019

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