Provider Demographics
NPI:1104027242
Name:PROFESSIONAL MEDICAL STAFFING CORP.
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL STAFFING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DISANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:1815-633-4100
Mailing Address - Street 1:6550 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4424
Mailing Address - Country:US
Mailing Address - Phone:181-565-4853
Mailing Address - Fax:181-565-4857
Practice Address - Street 1:6550 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4424
Practice Address - Country:US
Practice Address - Phone:181-565-4853
Practice Address - Fax:181-565-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2006-N0045251E00000X
IL1807563251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health