Basic Information
| Provider Information | |||||||||
| NPI: | 1205974433 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACUTE CARE SPECIALISTS II, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305458000 | ||||||||
| FaxNumber: | 6305455784 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 WINTHROP AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601391405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305458000 | ||||||||
| FaxNumber: | 6305455784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | MANN | ||||||||
| AuthorizedOfficialFirstName: | RUBY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 6308566884 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2223037 | 01 | IL | BCBS | OTHER |