| Northwest Medical Associates, Sc | |
|
30 E 15th St Suite 310 Chicago Heights IL 60411-3459 | |
| (708) 754-3225 | |
| Not Available |
| Full Name | Northwest Medical Associates, Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 30 E 15th St, Chicago Heights, Illinois |
| Authorized Official Name and Position | Charlotte Mitchell (SOLE OWNER) |
| Authorized Official Contact | 7087543225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Medical Associates, Sc 30 E 15th St Suite 310 Chicago Heights IL 60411-3459 Ph: (708) 754-3225 | Northwest Medical Associates, Sc 30 E 15th St Suite 310 Chicago Heights IL 60411-3459 Ph: (708) 754-3225 |
| NPI Number | 1700066453 |
|---|---|
| Provider Enumeration Date | 11/10/2007 |
| Last Update Date | 02/22/2014 |
| Medicare PECOS PAC ID | 4587745278 |
|---|---|
| Medicare Enrollment ID | O20080118000750 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700066453 | NPI | - | NPPES |
| 31603733 | Other | IL | BLUE CROSS |
| 036079491 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036079491 (Illinois) | Primary |
| Provider Name | Charlotte H Mitchell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508831918 PECOS PAC ID: 9133200827 Enrollment ID: I20080118000744 |
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