Family Primary Care Clinic | |
2424 Washington St Ste 208 Waukegan IL 60085-5077 | |
(224) 381-7672 | |
(224) 381-7969 |
Full Name | Family Primary Care Clinic |
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Speciality | Clinic/Center |
Location | 2424 Washington St Ste 208, Waukegan, Illinois |
Authorized Official Name and Position | Kimberly Tasigchana (NURSE PRACTITIONER) |
Authorized Official Contact | 2243817672 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Family Primary Care Clinic 2424 Washington St Ste 208 Waukegan IL 60085-5077 Ph: (224) 381-7672 | Family Primary Care Clinic 2424 Washington St Ste 208 Waukegan IL 60085-5077 Ph: (224) 381-7672 |
NPI Number | 1134540446 |
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Provider Enumeration Date | 01/04/2014 |
Last Update Date | 12/30/2020 |
Medicare PECOS PAC ID | 7911120118 |
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Medicare Enrollment ID | O20140515000590 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134540446 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 209.009079 (Illinois) | Primary |
Provider Name | Kimberly Ramirez-tasigchana |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992089742 PECOS PAC ID: 0143493965 Enrollment ID: I20111024000055 |
Provider Name | Alpha B Jarosz |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932479847 PECOS PAC ID: 0143415125 Enrollment ID: I20120613000341 |
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