Provider Demographics
NPI:1922305242
Name:FIDELIS HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:FIDELIS HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-605-0501
Mailing Address - Street 1:20 N MARTINGALE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-2412
Mailing Address - Country:US
Mailing Address - Phone:847-605-0501
Mailing Address - Fax:847-517-1085
Practice Address - Street 1:17625 EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3052
Practice Address - Country:US
Practice Address - Phone:281-954-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty