MEDICARE: MED STAFF ON-CALL

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	251J00000X	Nursing Care Agency	2011-N1142	IL

General Provider Information

NPI Number	:	1801171277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED STAFF ON-CALL

Provider Business Mailing Address
First Line	:	1332 N HALSTED ST
Second Line	:	SUITE 301
City	:	CHICAGO
State	:	IL
Zip	:	60642-2624
Country	:	US
Telephone Number	:	888-270-8374
Fax Number	:	888-288-7102

Provider Business Practice Location Address
First Line	:	1332 N HALSTED ST
Second Line	:	SUITE 301
City	:	CHICAGO
State	:	IL
Zip	:	60642-2624
Country	:	US
Telephone Number	:	888-270-8374
Fax Number	:	888-288-7102

Authorized Official
Title or Position	:	CEO
Name	:	DR. DENISE A KENT
Credential	:	PHD, APN, RN
Telephone Number	:	888-270-8374

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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