Basic Information
| Provider Information | |||||||||
| NPI: | 1558387084 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL CARDIAC SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 E 22ND ST | ||||||||
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| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601486110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308742542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W CENTRAL RD | ||||||||
| Address2: | NORTHWEST COMMUNITY HOSPITAL | ||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600052349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476181000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | TREANOR | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 8476181000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.