Basic Information
| Provider Information | |||||||||
| NPI: | 1972886612 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FIRST CHOICE CHICAGO, LLC | ||||||||
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| OtherOrganizationName: | MEDICAL ACCESS GROUP, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9999 W ROOSEVELT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601542775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089385238 | ||||||||
| FaxNumber: | 7089385239 | ||||||||
| Practice Location | |||||||||
| Address1: | 9999 W ROOSEVELT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601542775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089385238 | ||||||||
| FaxNumber: | 7089385239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2011 | ||||||||
| LastUpdateDate: | 10/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | VELMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7089385238 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.