Provider Demographics
NPI:1417278284
Name:BURRUSS HEALTH SERVICES
Entity Type:Organization
Organization Name:BURRUSS HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:708-323-7608
Mailing Address - Street 1:8045 S KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3418
Mailing Address - Country:US
Mailing Address - Phone:708-323-7608
Mailing Address - Fax:708-286-6461
Practice Address - Street 1:8045 S KIMBARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3418
Practice Address - Country:US
Practice Address - Phone:708-323-7608
Practice Address - Fax:708-286-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000359172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL181000359Medicaid