Provider Demographics
NPI:1912231036
Name:MOBILITY CENTER OF CHICAGO
Entity Type:Organization
Organization Name:MOBILITY CENTER OF CHICAGO
Other - Org Name:AMIGO MOBILITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:NOEMI
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-268-8670
Mailing Address - Street 1:17W620 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3768
Mailing Address - Country:US
Mailing Address - Phone:630-268-8670
Mailing Address - Fax:630-268-8667
Practice Address - Street 1:706 BLOOMINGTON RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-2563
Practice Address - Country:US
Practice Address - Phone:217-355-7971
Practice Address - Fax:217-355-8619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000634332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid