Provider Demographics
NPI:1497952048
Name:SPECIALTY MEDICAL SERVICES
Entity Type:Organization
Organization Name:SPECIALTY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:847-390-8939
Mailing Address - Street 1:479 E BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6037
Mailing Address - Country:US
Mailing Address - Phone:847-390-8939
Mailing Address - Fax:847-390-8937
Practice Address - Street 1:479 E BUSINESS CENTER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6037
Practice Address - Country:US
Practice Address - Phone:847-390-8939
Practice Address - Fax:847-390-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623063OtherBLUE CROSS PROVIDER NUMBE
ILCOF00453OtherABC ACCREDIDATION NUMBER