Provider Demographics
NPI:1689966533
Name:JSA OF ILLINOIS PC
Entity Type:Organization
Organization Name:JSA OF ILLINOIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-983-4479
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0543
Mailing Address - Country:US
Mailing Address - Phone:678-983-4479
Mailing Address - Fax:
Practice Address - Street 1:309 E RAND RD
Practice Address - Street 2:SUITE 347
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3103
Practice Address - Country:US
Practice Address - Phone:678-983-4479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty