Organization
WOODSON CENTER FOR ADULT HEALTHCARE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNNETTE MCROY (BILLING COORDINATOR)
(773) 767-3822
Entity
Organization
Contact information
Practice address
316 DIXIE HWY, CHICAGO HEIGHTS, IL 60411-1770
(708) 709-9200
(708) 756-0348
Mailing address
PO BOX 1097, BEDFORD PARK, IL 60499-1097
(708) 709-9200
(708) 756-0348
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036076317
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01626967
BCBS PROVIDER #
IL
05
—
036076317
—
IL
Enumeration date
07/31/2006
Last updated
07/23/2008
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