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Organization
PRESENCE HEALTHCARE SERVICES
Active
Organization
PRESENCE HEALTHCARE SERVICES
Active
Other names
Resurrection Services Presence Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR)
(630) 914-2417
Entity
Organization
Contact information
Practice address
9000 S STONY ISLAND AVE, CHICAGO, IL 60617-3508
(773) 731-0670
(773) 731-1714
Mailing address
1000 REMINGTON BOULEVARD, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036053397
IL
207R00000X
Internal Medicine Physician
036054086
IL
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
209007288
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053397
—
IL
05
—
036054086
—
IL
01
—
209007288
STATE LICENSE
IL
Enumeration date
08/24/2006
Last updated
04/10/2013
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