Provider Demographics
NPI:1457314130
Name:PRISM HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PRISM HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-230-8835
Mailing Address - Street 1:1337 BASSWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4536
Mailing Address - Country:US
Mailing Address - Phone:847-310-4730
Mailing Address - Fax:847-310-4735
Practice Address - Street 1:1337 BASSWOOD ROAD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4536
Practice Address - Country:US
Practice Address - Phone:847-310-4730
Practice Address - Fax:872-469-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000156332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1297960001Medicare NSC
IL1297960001Medicare NSC