Provider Demographics
NPI:1295526655
Name:MILES OF CARE BRIM DIVISION
Entity type:Organization
Organization Name:MILES OF CARE BRIM DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:773-960-1202
Mailing Address - Street 1:PO BOX 19111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-0002
Mailing Address - Country:US
Mailing Address - Phone:773-960-1202
Mailing Address - Fax:708-933-3459
Practice Address - Street 1:10408 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2508
Practice Address - Country:US
Practice Address - Phone:773-960-1202
Practice Address - Fax:708-933-3459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES OF CARE INFUSION & WELLNESS DIVISON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center