Resurrection Services Presence Medical Group

LBN: Presence Healthcare Services
Resurrection Services Presence Medical Group is an health care organization with primary practice located at 9000 S Stony Island Ave , Chicago IL 60617-3508. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / Internal Medicine is the primary health care specialty. Presence Healthcare Services can be contacted via phone (773) 731-0670, or through Wickliffe-Jones, Melvonne via phone (630) 914-2417.

Contact Information

Primary practice address
9000 S Stony Island Ave Chicago IL 60617-3508
Phone: (773) 731-0670
Fax: (773) 731-1714
Website:
Map and Directions
Authorized official contact:
Name: Wickliffe-Jones, Melvonne
Phone: (630) 914-2417

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036053397 Illinois
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036054086 Illinois
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209007288 Illinois

Profile Details

NPI number 1922115864
LBN Legal business name Presence Healthcare Services
DBA Doing business as Resurrection Services Presence Medical Group
Authorized official Wickliffe-Jones, Melvonne
Entity Organization
Organization subpart 1 No
Enumeration date Aug 24th, 2006
Last updated Apr 10th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922115864 NPPES
Illinois MEDICAID 036053397
Illinois Other 209007288
Illinois MEDICAID 036054086

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