Provider Demographics
NPI:1801171277
Name:MED STAFF ON-CALL
Entity type:Organization
Organization Name:MED STAFF ON-CALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APN, RN
Authorized Official - Phone:888-270-8374
Mailing Address - Street 1:1332 N HALSTED ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2624
Mailing Address - Country:US
Mailing Address - Phone:888-270-8374
Mailing Address - Fax:888-288-7102
Practice Address - Street 1:1332 N HALSTED ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2624
Practice Address - Country:US
Practice Address - Phone:888-270-8374
Practice Address - Fax:888-288-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2011-N1142251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care