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PRESENCE HEALTHCARE SERVICES NPI 1790078053


NPI Information

NPI: 1790078053
Provider Name: PRESENCE HEALTHCARE SERVICES

Former Legal Business Name: RESURRECTION SERVICES

Classification: Internal Medicine - 207RA0201X
Entity Type: Organization

Specialization: Allergy & Immunology

Address:
2800 N SHERIDAN RD
SUITE 309
CHICAGO, IL
ZIP 60657
Phone: (773) 871-4183
Get Directions

PRESENCE HEALTHCARE SERVICES is an allergy and immunology internal medicine in Chicago, IL. The provider is an internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology. PRESENCE HEALTHCARE SERVICES NPI is 1790078053. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Resurrection Services.

The provider's business location address is:

2800 N SHERIDAN RD
SUITE 309
CHICAGO, IL
ZIP 60657-156
Phone: (773) 871-4183
Fax: (773) 883-1202

The provider's authorized official is Melvonne Wickliffe-jones .
The authorized official title is Credentialing Mgr and has the following contact phone number (630) 914-2417.

The enumeration date for this NPI number is 5/19/2011 and was last updated on 4/10/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207K00000XAllergy & Immunology036043445ILLINOISNo
2207RA0201XInternal MedicineAllergy & Immunology036043445ILLINOISNo
3207RA0201XInternal MedicineAllergy & ImmunologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1036043445MEDICAIDILLINOIS
2745367MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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