Provider Demographics
NPI:1588617260
Name:LITTLE COMPANY OF MARY AFFILIATED SERVICES INC
Entity Type:Organization
Organization Name:LITTLE COMPANY OF MARY AFFILIATED SERVICES INC
Other - Org Name:LITTLE CO OF MARY AFFILIATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-229-5171
Mailing Address - Street 1:2800 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2701
Mailing Address - Country:US
Mailing Address - Phone:708-229-5171
Mailing Address - Fax:708-229-4209
Practice Address - Street 1:2800 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2701
Practice Address - Country:US
Practice Address - Phone:708-229-5171
Practice Address - Fax:708-229-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC2999OtherRAILROAD MEDICARE
IL01620807OtherBLUE CROSS BLUE SHIELD
ILCC2999OtherRAILROAD MEDICARE