| Park Primary Care Ltd | |
|
9760 S Kedzie Ave Suite 2 Evergreen Park IL 60805-3109 | |
| (708) 423-8150 | |
| (708) 423-8152 |
| Full Name | Park Primary Care Ltd |
|---|---|
| Speciality | General Practice |
| Location | 9760 S Kedzie Ave, Evergreen Park, Illinois |
| Authorized Official Name and Position | Thomas Joseph (OWNER) |
| Authorized Official Contact | 7084238150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Primary Care Ltd 9760 S Kedzie Ave Suite 2 Evergreen Park IL 60805-3109 Ph: (708) 423-8150 | Park Primary Care Ltd 9760 S Kedzie Ave Suite 2 Evergreen Park IL 60805-3109 Ph: (708) 423-8150 |
| NPI Number | 1891984068 |
|---|---|
| Provider Enumeration Date | 10/23/2007 |
| Last Update Date | 03/16/2009 |
| Medicare PECOS PAC ID | 5698797256 |
|---|---|
| Medicare Enrollment ID | O20051222000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891984068 | NPI | - | NPPES |
| CA1215 | Other | IL | RAILROAD MEDICARE |
| 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 |
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