Provider Demographics
NPI:1932212610
Name:DIRECTMED HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIRECTMED HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN, ASST
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-642-5500
Mailing Address - Street 1:2600 S. MICHIGAN AVE
Mailing Address - Street 2:STE. 303
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-642-5500
Mailing Address - Fax:312-642-5501
Practice Address - Street 1:2600 S. MICHIGAN AVE
Practice Address - Street 2:STE. 303
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-642-5500
Practice Address - Fax:312-642-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010443251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL75317990001Medicaid
IL01635410OtherBLUE CROSS BLUE SHIELD
IL=========OtherPHCS