Provider Demographics
NPI:1609479823
Name:MIDWEST PROFESSIONAL SERVICE PROVIDERS
Entity Type:Organization
Organization Name:MIDWEST PROFESSIONAL SERVICE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-647-0199
Mailing Address - Street 1:7831 ROBERT ROADS # 2
Mailing Address - Street 2:
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60455-7309
Mailing Address - Country:US
Mailing Address - Phone:773-647-0199
Mailing Address - Fax:
Practice Address - Street 1:7831 ROBERT ROADS # 2
Practice Address - Street 2:
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60455-7309
Practice Address - Country:US
Practice Address - Phone:773-647-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy