<Unavail>

LBN: Itic Support Services Group Llc
<Unavail> is an health care organization with primary practice located at 141 Market Pl , Fairview Heights IL 62208-2034. The organization recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Allopathic & Osteopathic Physicians / Psychiatry, Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty. Itic Support Services Group Llc can be contacted via phone (314) 238-5260, or through Morris, Ryan W via phone (314) 238-5260.

Contact Information

Primary practice address
141 Market Pl Fairview Heights IL 62208-2034
Phone: (314) 238-5260
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Morris, Ryan W
Phone: (314) 238-5260

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X

Profile Details

NPI number 1972074516
LBN Legal business name Itic Support Services Group Llc
DBA Doing business as <Unavail>
Authorized official Morris, Ryan W
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 7th, 2018
Last updated Aug 27th, 2019 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1972074516 NPPES
Illinois MEDICAID 1164929055

Popular Providers