Provider Demographics
NPI:1679048334
Name:PHOCUSED CONSULTING LLC
Entity Type:Organization
Organization Name:PHOCUSED CONSULTING LLC
Other - Org Name:PHOCUSED ON SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-878-3016
Mailing Address - Street 1:24644 S MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3789
Mailing Address - Country:US
Mailing Address - Phone:708-878-3016
Mailing Address - Fax:
Practice Address - Street 1:1324 E 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3402
Practice Address - Country:US
Practice Address - Phone:773-221-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental