Provider Demographics
NPI:1588847784
Name:TINLEY WOODS
Entity Type:Organization
Organization Name:TINLEY WOODS
Other - Org Name:GI ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OMALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MRS
Authorized Official - Phone:708-424-1202
Mailing Address - Street 1:18210 LA GRANGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7722
Mailing Address - Country:US
Mailing Address - Phone:708-424-1202
Mailing Address - Fax:708-424-1395
Practice Address - Street 1:10500 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5205
Practice Address - Country:US
Practice Address - Phone:708-424-1202
Practice Address - Fax:708-424-1395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GI ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL37309Medicare UPIN
ILK30566Medicare UPIN