Provider Demographics
NPI:1477798478
Name:CHS ILLINOIS MEDICAL, S.C.
Entity Type:Organization
Organization Name:CHS ILLINOIS MEDICAL, S.C.
Other - Org Name:CHOOSE HEALTH WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-577-4927
Mailing Address - Street 1:5500 MARYLAND WAY
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 OVERLOOK PT
Practice Address - Street 2:40A-LL-WC
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4302
Practice Address - Country:US
Practice Address - Phone:847-613-4654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty