Organization
MEDIC 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY DIETZE (DIRECTOR OF PATIENT ACCOUNTS)
(708) 670-1221
Entity
Organization
Contact information
Practice address
9850 W 190TH ST, SUITE A, MOKENA, IL 60448-5604
(708) 670-1221
(708) 478-1628
Mailing address
9850 W 190TH ST, SUITE A, MOKENA, IL 60448-5604
(708) 670-1221
(708) 478-1628
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
APPLIED FOR
IL
Other
Enumeration date
02/19/2013
Last updated
02/19/2013
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