| Evergreen Care Center Ltd | |
|
9760 S Kedzie Ave Suite 3 Evergreen Park IL 60805-3109 | |
| (708) 423-6209 | |
| (708) 423-9021 |
| Full Name | Evergreen Care Center Ltd |
|---|---|
| Speciality | General Practice |
| Location | 9760 S Kedzie Ave, Evergreen Park, Illinois |
| Authorized Official Name and Position | Thomas Joseph (OWNER) |
| Authorized Official Contact | 7084236209 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Care Center Ltd 9760 S Kedzie Ave Suite 3 Evergreen Park IL 60805-3109 Ph: (708) 423-6209 | Evergreen Care Center Ltd 9760 S Kedzie Ave Suite 3 Evergreen Park IL 60805-3109 Ph: (708) 423-6209 |
| NPI Number | 1447449616 |
|---|---|
| Provider Enumeration Date | 10/23/2007 |
| Last Update Date | 07/19/2010 |
| Medicare PECOS PAC ID | 2163317124 |
|---|---|
| Medicare Enrollment ID | O20040218000589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447449616 | NPI | - | NPPES |
| DA0131 | Other | IL | RAIL ROAD MEDICARE |
| 036084895 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Shefali K Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609815414 PECOS PAC ID: 5991725798 Enrollment ID: I20051122000680 |
| Provider Name | Thomas Joseph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306836663 PECOS PAC ID: 2668367640 Enrollment ID: I20051227000105 |
| Provider Name | George Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073746046 PECOS PAC ID: 7911153606 Enrollment ID: I20120813000387 |
| Provider Name | Kristina Ann Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841587334 PECOS PAC ID: 7214244573 Enrollment ID: I20150918000631 |
Stanley A Polit Md, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2850 W 95th St, Suite 11, Evergreen Park, IL 60805 Phone: 708-424-9044 Fax: 708-424-1799 | |
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