Provider Demographics
NPI:1114099538
Name:LITTLE COMPANY OF MARY HEALTH PROVIDERS
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY HEALTH PROVIDERS
Other - Org Name:SOUTHWEST HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-342-7144
Mailing Address - Street 1:18410 CROSSING DR STE A
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-9287
Mailing Address - Country:US
Mailing Address - Phone:708-342-7171
Mailing Address - Fax:
Practice Address - Street 1:18410 CROSSING DR STE A
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-9287
Practice Address - Country:US
Practice Address - Phone:708-342-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization