Provider Demographics
NPI:1609234202
Name:OAK STREET PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:OAK STREET PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GRIFFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-600-8484
Mailing Address - Street 1:213 N RACINE AVE
Mailing Address - Street 2:100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1644
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:213 N RACINE AVE
Practice Address - Street 2:100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1644
Practice Address - Country:US
Practice Address - Phone:312-733-9730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK STREET HEALTH MSO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-10
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty