Provider Demographics
NPI:1376297168
Name:MASON MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:MASON MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAU
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-531-7579
Mailing Address - Street 1:9400 S BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3600
Mailing Address - Country:US
Mailing Address - Phone:469-636-7501
Mailing Address - Fax:
Practice Address - Street 1:9400 S BENNETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3600
Practice Address - Country:US
Practice Address - Phone:469-636-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASON MEDICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-09
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare