Provider Demographics
NPI:1063871390
Name:PRACTICE MANAGEMENT SOLUTIONS LLC
Entity type:Organization
Organization Name:PRACTICE MANAGEMENT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-477-8844
Mailing Address - Street 1:6119 NORTHWEST HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7911
Mailing Address - Country:US
Mailing Address - Phone:815-477-8844
Mailing Address - Fax:815-308-3387
Practice Address - Street 1:6119 NORTHWEST HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7911
Practice Address - Country:US
Practice Address - Phone:815-477-8844
Practice Address - Fax:815-308-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.008097111NR0400X
IL038.006954111NR0400X
IL038.009872111NR0400X
IL085.004468363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400270913Medicare PIN
ILIL5317006Medicare PIN