Basic Information
| Provider Information | |||||||||
| NPI: | 1255622023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE RENAISSANCE PARK SOUTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7257 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479332600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10935 S HALSTED ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606283127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739282000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | KOPSIAS | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RESIDENT ACCT & BILLING | ||||||||
| AuthorizedOfficialTelephone: | 8477456226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 0049098 | IL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
No ID Information.