Individual ProviderJustin SpackeyRadiologyAllopathic & Osteopathic PhysiciansPractice Address2160 S First Ave, Maywood, IL 60153(708) 216-1084PECOS EnrollmentBased on the most recent information from CMS, provider Justin Spackey is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1831353788Provider TypeIndividualFull NameSpackey, JustinCredentialMDGenderMaleSole ProprietorYesEnumeration Date7/10/2008Last Updated7/10/2008Contact InformationPractice LocationPractice Address2160 S First Ave, Maywood, IL 60153Phone(708) 216-1084FaxUnlisted FaxMailing LocationMailing Address586 Oak St, Elk Grove Village, IL 60007-4210PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense125052016Illinois