Provider Demographics
NPI:1841214525
Name:PAIN SPECIALISTS OF GREATER CHICAGO SC
Entity Type:Organization
Organization Name:PAIN SPECIALISTS OF GREATER CHICAGO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-371-9980
Mailing Address - Street 1:7055 HIGH GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7593
Mailing Address - Country:US
Mailing Address - Phone:630-371-9980
Mailing Address - Fax:630-371-9983
Practice Address - Street 1:7055 HIGH GROVE BLVD
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7593
Practice Address - Country:US
Practice Address - Phone:630-371-9980
Practice Address - Fax:630-371-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078362OtherBLUE CROSS
IL036078362OtherBLUE CROSS
ILF07118Medicare UPIN
ILF07118Medicare UPIN
IL036082680Medicaid