Basic Information
| Provider Information | |||||||||
| NPI: | 1174886840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESURRECTION SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 62311 COLLECTION CENTER DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606930623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002732614 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5322 W FULLERTON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606391425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736220056 | ||||||||
| FaxNumber: | 7736221095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | GARRISON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7739907677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.