Provider Demographics
NPI:1437693355
Name:AR TELEMEDICINE OF ILLINOIS SC
Entity Type:Organization
Organization Name:AR TELEMEDICINE OF ILLINOIS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-878-2833
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-0663
Mailing Address - Country:US
Mailing Address - Phone:855-629-8353
Mailing Address - Fax:
Practice Address - Street 1:4336 ENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1806
Practice Address - Country:US
Practice Address - Phone:855-629-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty