Provider Demographics
NPI:1144686676
Name:FLAWLESS SERVICE CORPORATION
Entity type:Organization
Organization Name:FLAWLESS SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:TINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-222-0030
Mailing Address - Street 1:PO BOX 804193
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4103
Mailing Address - Country:US
Mailing Address - Phone:312-222-0030
Mailing Address - Fax:
Practice Address - Street 1:1272 WINSTON PLZ
Practice Address - Street 2:MELROSE PARK CLINIC
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1507
Practice Address - Country:US
Practice Address - Phone:708-615-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079325261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service