Provider Demographics
NPI:1386796803
Name:PHYSICIAN HOUSE-CALL SERVICES, INC
Entity type:Organization
Organization Name:PHYSICIAN HOUSE-CALL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REA
Authorized Official - Middle Name:STAVROPOULOS
Authorized Official - Last Name:LORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-941-9344
Mailing Address - Street 1:105 SOUTH YORK ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-941-9344
Mailing Address - Fax:630-941-1486
Practice Address - Street 1:105 SOUTH YORK ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-941-9344
Practice Address - Fax:630-941-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL61509097174400000X
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207898Medicare PIN