Provider Demographics
NPI:1386814689
Name:CHICAGO MEDICAL MOBILITY HEATHCARE SERVICES
Entity Type:Organization
Organization Name:CHICAGO MEDICAL MOBILITY HEATHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:U
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-949-9844
Mailing Address - Street 1:2721 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5906
Mailing Address - Country:US
Mailing Address - Phone:312-949-9844
Mailing Address - Fax:312-949-9842
Practice Address - Street 1:2721 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5906
Practice Address - Country:US
Practice Address - Phone:312-949-9844
Practice Address - Fax:312-949-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6196120001Medicare NSC