Provider Demographics
NPI:1063871747
Name:BSMC-AOM INC
Entity type:Organization
Organization Name:BSMC-AOM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,DD
Authorized Official - Phone:708-848-1277
Mailing Address - Street 1:1101 LAKE ST
Mailing Address - Street 2:210
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1046
Mailing Address - Country:US
Mailing Address - Phone:708-848-1277
Mailing Address - Fax:708-848-8234
Practice Address - Street 1:1101 LAKE ST
Practice Address - Street 2:210
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1046
Practice Address - Country:US
Practice Address - Phone:708-848-1277
Practice Address - Fax:708-848-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X, 174H00000X
IL227004153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty