| Fvo Primary Llc | |
|
1710 N Randall Rd Ste 140 Elgin IL 60123-9401 | |
| (630) 584-1400 | |
| Not Available |
| Full Name | Fvo Primary Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1710 N Randall Rd Ste 140, Elgin, Illinois |
| Authorized Official Name and Position | Debbie Navigato (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 6309384011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fvo Primary Llc 2525 Kaneville Rd Geneva IL 60134-2578 Ph: (630) 584-1400 | Fvo Primary Llc 1710 N Randall Rd Ste 140 Elgin IL 60123-9401 Ph: (630) 584-1400 |
| NPI Number | 1467146100 |
|---|---|
| Provider Enumeration Date | 06/06/2023 |
| Last Update Date | 06/06/2023 |
| Medicare PECOS PAC ID | 1557711678 |
|---|---|
| Medicare Enrollment ID | O20240102001013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467146100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Michael Hernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972501096 PECOS PAC ID: 3072509579 Enrollment ID: I20040422001562 |
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