Provider Demographics
NPI:1902900251
Name:CAL-PARK HEALTH ASSOCIATES LTD
Entity Type:Organization
Organization Name:CAL-PARK HEALTH ASSOCIATES LTD
Other - Org Name:CALUMET PARK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:708-389-3636
Mailing Address - Street 1:1328 W 127TH STREET
Mailing Address - Street 2:
Mailing Address - City:CALUMET PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60827-6129
Mailing Address - Country:US
Mailing Address - Phone:708-389-3636
Mailing Address - Fax:708-389-8956
Practice Address - Street 1:1328 W 127TH STREET
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60827-6129
Practice Address - Country:US
Practice Address - Phone:708-389-3636
Practice Address - Fax:708-389-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization