| Lemont Primary Care, Sc | |
|
15505 127th St Lemont IL 60439-4433 | |
| (630) 257-2265 | |
| Not Available |
| Full Name | Lemont Primary Care, Sc |
|---|---|
| Speciality | Pediatrics |
| Location | 15505 127th St, Lemont, Illinois |
| Authorized Official Name and Position | Kenneth Porter (PRESIDENT) |
| Authorized Official Contact | 6302572265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lemont Primary Care, Sc 15505 127th St Lemont IL 60439-4433 Ph: (630) 257-2265 | Lemont Primary Care, Sc 15505 127th St Lemont IL 60439-4433 Ph: (630) 257-2265 |
| NPI Number | 1558477034 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1153519822 |
|---|---|
| Medicare Enrollment ID | O20101222000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558477034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Catherine Baker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871609354 PECOS PAC ID: 8022206796 Enrollment ID: I20101222000081 |
| Provider Name | Kenneth Porter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174639645 PECOS PAC ID: 5496943169 Enrollment ID: I20110104000033 |
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