Provider Demographics
NPI:1811997885
Name:PALOS EMERGENCY MEDICAL SERVICES, LTD
Entity type:Organization
Organization Name:PALOS EMERGENCY MEDICAL SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHOCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-233-8709
Mailing Address - Street 1:9944 S ROBERTS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1555
Mailing Address - Country:US
Mailing Address - Phone:708-430-8282
Mailing Address - Fax:708-599-1552
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1256
Practice Address - Country:US
Practice Address - Phone:708-923-5800
Practice Address - Fax:708-923-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC2175Medicare PIN
CF6550Medicare PIN
IL762690Medicare PIN