Provider Demographics
NPI:1528003126
Name:PRS, LLC
Entity Type:Organization
Organization Name:PRS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-372-4243
Mailing Address - Street 1:188 W INDUSTRIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:188 W INDUSTRIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1623
Practice Address - Country:US
Practice Address - Phone:630-359-3238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
50655OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
50655OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL=========001Medicaid