Provider Demographics
NPI:1821607425
Name:DESIRED MEDICAL SERVICES INCORPORATED
Entity type:Organization
Organization Name:DESIRED MEDICAL SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANNEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:708-394-3296
Mailing Address - Street 1:3224 RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3191
Mailing Address - Country:US
Mailing Address - Phone:708-394-3296
Mailing Address - Fax:
Practice Address - Street 1:3224 RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3191
Practice Address - Country:US
Practice Address - Phone:708-394-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL277.000158Medicaid