Basic Information
| Provider Information | |||||||||
| NPI: | 1588991368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESURRECTION AMBULATORY SERVICES | ||||||||
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| OtherOrganizationName: | RESURRECTION AMBULATORY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6670 | ||||||||
| Address2: | |||||||||
| City: | RIVER FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603056670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086758160 | ||||||||
| FaxNumber: | 7083647474 | ||||||||
| Practice Location | |||||||||
| Address1: | 2433 N HARLEM AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607072031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738896355 | ||||||||
| FaxNumber: | 7733552815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2009 | ||||||||
| LastUpdateDate: | 03/15/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOBSON | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7737973603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QR0206X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | 261QR0404X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Cardiac Facilities | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.