| Organization Name: | PRESENCE AMBULATORY SERVICES |
| NPI Number: | 1114253812 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR) |
| Mailing Address: | 4900 N Cumberland Ave Norridge |
| State: | IL US |
| Postal Code: | 607062916 |
| Phone Number: | 7084561600 |
| Fax Number: | 7084632781 |
| NPI Enumeration Date: | 10/30/2009 |
| NPI Last Update Date: | 05/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |