Organization
BLACKBAG HOME PHYSICIAN SERVICE LLC
Active
Organization
BLACKBAG HOME PHYSICIAN SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHELLE HAMPTON (CHIEF EXECUTIVE OFFICER)
(312) 399-0285
Entity
Organization
Contact information
Practice address
437 NAVAJO ST, PARK FOREST, IL 60466-2520
(815) 406-5011
(888) 311-8610
Mailing address
21200 S LAGRANGE RD, 305, FRANKFORT, IL 60423-2003
(815) 406-5011
(888) 311-8610
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
03/09/2013
Last updated
12/21/2014
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