Organization
AMERICAN HOSPITAL SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRYK J ROZTOCZYNSKI MD, PHD (PRESIDENT)
(773) 745-8434
Entity
Organization
Contact information
Practice address
6157 W BELMONT AVE, CHICAGO, IL 60634-4004
(773) 745-8434
(773) 745-3443
Mailing address
6157 W BELMONT AVE, CHICAGO, IL 60634-4004
(773) 745-8434
(773) 745-3443
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036058369
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058369
—
IL
01
—
14D0878232
CLIA
IL
01
—
31600059
BCBS
IL
01
—
AR8609236
FDA
IL
Enumeration date
09/27/2010
Last updated
10/21/2015
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