Organization
LITTLE COMPANY OF MARY AFFILIATED SERVICES INC
Active
Other names
LITTLE CO OF MARY AFFILIATED
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL A HEENAN (DIRECTOR PROFESSIONAL SERVICES)
(708) 229-5171
Entity
Organization
Contact information
Practice address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2701
(708) 229-5171
(708) 229-4209
Mailing address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2701
(708) 229-5171
(708) 229-4209
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01620807
BLUE CROSS BLUE SHIELD
IL
01
—
CC2999
RAILROAD MEDICARE
IL
Enumeration date
05/17/2006
Last updated
02/22/2010
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