Provider Demographics
NPI:1134686439
Name:QUALSIGHT LLC
Entity Type:Organization
Organization Name:QUALSIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGEMENT
Authorized Official - Phone:773-350-3357
Mailing Address - Street 1:9525 BRYN MAWR AVE STE 725
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5262
Mailing Address - Country:US
Mailing Address - Phone:773-350-3357
Mailing Address - Fax:773-632-4132
Practice Address - Street 1:9525 BRYN MAWR AVE STE 725
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-5262
Practice Address - Country:US
Practice Address - Phone:773-350-3357
Practice Address - Fax:773-632-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB25143270224OtherID