Provider Demographics
NPI:1922068477
Name:WATERMARK PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:WATERMARK PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-783-2410
Mailing Address - Street 1:7222 W CERMAK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1422
Mailing Address - Country:US
Mailing Address - Phone:708-783-2410
Mailing Address - Fax:708-783-2452
Practice Address - Street 1:7222 W CERMAK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1422
Practice Address - Country:US
Practice Address - Phone:708-783-2410
Practice Address - Fax:708-783-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center