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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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