Provider Demographics
NPI:1962664268
Name:JIL MEDICAL CONSULTANT
Entity Type:Organization
Organization Name:JIL MEDICAL CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:773-776-8800
Mailing Address - Street 1:5500 S DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-1107
Mailing Address - Country:US
Mailing Address - Phone:773-776-8800
Mailing Address - Fax:773-776-8801
Practice Address - Street 1:5500 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-1107
Practice Address - Country:US
Practice Address - Phone:773-776-8800
Practice Address - Fax:773-776-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-09434261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health