Provider Demographics
NPI:1215379524
Name:MASS MEDICAL, S.C.
Entity Type:Organization
Organization Name:MASS MEDICAL, S.C.
Other - Org Name:LAKE FOREST ACUTE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-814-9376
Mailing Address - Street 1:475 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-3349
Mailing Address - Country:US
Mailing Address - Phone:847-814-9376
Mailing Address - Fax:
Practice Address - Street 1:1025 W EVERETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2697
Practice Address - Country:US
Practice Address - Phone:847-234-7950
Practice Address - Fax:847-234-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
IL042620111261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine