Provider Demographics
NPI:1255844486
Name:JEFFERSON DIABETES CONSULTANTS, L.L.C.
Entity Type:Organization
Organization Name:JEFFERSON DIABETES CONSULTANTS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CDCES
Authorized Official - Phone:312-488-9392
Mailing Address - Street 1:9449 S KEDZIE AVE # 560
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:312-488-9392
Mailing Address - Fax:
Practice Address - Street 1:9449 S KEDZIE AVE # 560
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:312-488-9392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service