1427405042 NPI number — DYNAMIC HEALTHCARE SERVICES INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427405042 NPI number — DYNAMIC HEALTHCARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC HEALTHCARE SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427405042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
256 LAKEWOOD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60466-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-750-1045
Provider Business Mailing Address Fax Number:
708-300-6869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 LAKEWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FOREST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60466-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-750-1045
Provider Business Practice Location Address Fax Number:
708-300-6869
Provider Enumeration Date:
05/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
AYOGHU
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
U
Authorized Official Title or Position:
AGENCY MANAGER
Authorized Official Telephone Number:
773-750-1045

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  4000485 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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