Individual ProviderTejuana GroomsPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1901 W Harrison St, Fantus Family Planning Clinic 4th Floor, Chicago, IL 60612-3714(708) 945-9206PECOS EnrollmentBased on the most recent information from CMS, provider Tejuana Grooms is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1073753125Provider TypeIndividualFull NameGrooms, TejuanaCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date3/3/2009Last Updated3/30/2012Contact InformationPractice LocationPractice Address1901 W Harrison St, Fantus Family Planning Clinic 4th Floor, Chicago, IL 60612-3714Phone(708) 945-9206FaxUnlisted FaxMailing LocationMailing Address1901 W Harrison St, Fantus Family Planning Clinic 4th Floor, Chicago, IL 60612-3714Phone(708) 945-9206FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense085.003340Illinois