Provider Demographics
NPI:1831358183
Name:CRIMSON ARK MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:CRIMSON ARK MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MOHINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-758-0630
Mailing Address - Street 1:386 N YORK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2363
Mailing Address - Country:US
Mailing Address - Phone:630-758-0630
Mailing Address - Fax:630-758-0632
Practice Address - Street 1:516 S FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3731
Practice Address - Country:US
Practice Address - Phone:630-254-4337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL314990OtherMEDICARE FOR COOK COUNTY
IL0001621386OtherBCBS
IL036089371Medicaid
IL704890OtherMEDICARE DUPAGE COUNTY
IL704890OtherMEDICARE DUPAGE COUNTY