Provider Demographics
NPI:1336260272
Name:DIAGNOSTIC SERVICES ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:DIAGNOSTIC SERVICES ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROTTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-422-3680
Mailing Address - Street 1:18861 90TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8178
Mailing Address - Country:US
Mailing Address - Phone:708-422-3680
Mailing Address - Fax:
Practice Address - Street 1:18861 90TH AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8371
Practice Address - Country:US
Practice Address - Phone:708-422-3680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622113Medicare UPIN