South Lake Medical Services, LTD

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

License

036049708 Issued in IL

Legal business name

SOUTH LAKE MEDICAL SERVICES, LTD

Practice address

2621 E 75TH St
Chicago, IL 60649-3705

Phone

(773) 375-1900

Fax

(773) 375-8279

NPI assigned

May 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria C Thachenkery, M.D

Title

President

Phone

(773) 375-1900

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1407023849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 E 75TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493705",
            "telephone_number": "773-375-1900",
            "fax_number": "773-375-8279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 E 75TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606493705",
            "telephone_number": "773-375-1900",
            "fax_number": "773-375-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE MEDICAL SERVICES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "THACHENKERY",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-375-1900",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "IL",
            "license": "036049708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• South Loop Living & Rehab Center LLC (Warren Barr South Loop)
• South Loop Massage LLC
• South Loop Pediatric Therapy LLC

• Adult Day Care Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Day Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.