| Primesource Healthcare Systems, Inc. | |
|
2100 East Lake Cook Road Suite 1100 Buffalo Grove IL 60089-1815 | |
| (800) 317-0711 | |
| (877) 821-6402 |
| Full Name | Primesource Healthcare Systems, Inc. |
|---|---|
| Speciality | Podiatrist |
| Location | 2100 East Lake Cook Road, Buffalo Grove, Illinois |
| Authorized Official Name and Position | David Fleming (PRESIDENT & CEO) |
| Authorized Official Contact | 8003170711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primesource Healthcare Systems, Inc. 2100 East Lake Cook Road Suite 1100 Buffalo Grove IL 60089-1815 Ph: (800) 317-0711 | Primesource Healthcare Systems, Inc. 2100 East Lake Cook Road Suite 1100 Buffalo Grove IL 60089-1815 Ph: (800) 317-0711 |
| NPI Number | 1497704126 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 02/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497704126 | NPI | - | NPPES |
| 100052700 | Medicaid | IN | |
| 200109050 | Medicaid | IN | |
| 000000175113 | Other | IN | ANTHEM |
| 200378850A | Medicaid | IN |
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