Provider Demographics
NPI:1265665301
Name:SPECIALTY HEALTHCARE SERVICES, LTD.
Entity Type:Organization
Organization Name:SPECIALTY HEALTHCARE SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:UNTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-880-6040
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0636
Mailing Address - Country:US
Mailing Address - Phone:773-880-6040
Mailing Address - Fax:773-880-6107
Practice Address - Street 1:830 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-880-6040
Practice Address - Fax:773-880-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty