Basic Information
| Provider Information | |||||||||
| NPI: | 1407002108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWEDISH COVENANT MANAGEMENT SERVICES, INC. | ||||||||
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| OtherOrganizationName: | COMPREHENSIVE WELLNESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5019 N MOZART ST | ||||||||
| Address2: | ATTN: SOULTANA AMAXOPOULOS | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732933223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2825 N HALSTED ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735498900 | ||||||||
| FaxNumber: | 7735498511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | KRUGEL | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT,OPERATION/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7738788200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036117858 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | 036-086740 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.