Medical Service and Support LLC MBFS

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

License

01883194 Issued in IL

Legal business name

MEDICAL SERVICE AND SUPPORT LLC MBFS

Practice address

500 Linden Avenue
Oak Park, IL 60302-1659

Phone

(773) 746-6050

NPI assigned

Dec 19, 2006

Organization subpart

No

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

Authorized official

Name

Rengaraju Ganesan, MBA

Title

MD

Phone

(773) 746-6050

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851454664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 LINDEN AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021659",
            "telephone_number": "773-746-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LINDEN AVENUE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021659",
            "telephone_number": "773-746-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SERVICE AND SUPPORT LLC MBFS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANESAN",
        "authorized_official_first_name": "RENGARAJU",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "773-746-6050",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "IL",
            "license": "01883194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Supports Brokerage Agency in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Supports Brokerage Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.