Provider Demographics
NPI:1689163875
Name:VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC
Entity Type:Organization
Organization Name:VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRES FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:P.
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-654-2711
Mailing Address - Street 1:210 S DES PLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2721
Mailing Address - Fax:866-954-5804
Practice Address - Street 1:1701 W MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4257
Practice Address - Country:US
Practice Address - Phone:773-366-8035
Practice Address - Fax:773-881-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical