Organization
PRESENCE AMBULATORY SERVICES
Active
Parent organization
PRESENCE HEALTHCARE SERVICES
Other names
PRESENCE NORTHSHORE PHYSICIANS GROUP ADVANCED IMAGING CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRESENCE HEALTHCARE SERVICES
Authorized official
MELVONNE WICKLIFFE-JONES (MANAGER, CREDENTIALING & PROVIDER R)
(630) 914-2417
Entity
Organization
Contact information
Practice address
9312 SKOKIE BLVD, SKOKIE, IL 60077-1309
(847) 329-7788
Mailing address
1000 REMINGTON BLVD, SUITE 100, BOLINGBROOK, IL 60440-5114
(630) 914-2417
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
12/19/2012
Last updated
03/12/2013
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