NPI | 1891386116 |
---|---|
Entity Type | Organization |
Authorized Contact | MARY JOAN MACKNISKAS Sr Director Of Net Revenue 773-213-0776 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization |
Enumeration Date | 2021-01-29 |
Last Update Date | 2021-01-29 |