| Prairie Medical Group | |
|
2434 Wolf Rd Westchester IL 60154-5634 | |
| (708) 562-5430 | |
| (708) 562-8330 |
| Full Name | Prairie Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2434 Wolf Rd, Westchester, Illinois |
| Authorized Official Name and Position | Thomas M Nelson (MANAGING PARTNER) |
| Authorized Official Contact | 7085625430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Medical Group 2434 Wolf Rd Westchester IL 60154-5634 Ph: (708) 562-5430 | Prairie Medical Group 2434 Wolf Rd Westchester IL 60154-5634 Ph: (708) 562-5430 |
| NPI Number | 1508995762 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 05/15/2013 |
| Medicare PECOS PAC ID | 4688657505 |
|---|---|
| Medicare Enrollment ID | O20040611000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508995762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 3336C0003X | Pharmacy - Community/retail Pharmacy | (* (Not Available)) | Secondary |
| Provider Name | Angela M Zekios |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952352254 PECOS PAC ID: 6709869522 Enrollment ID: I20040713000541 |
| Provider Name | Kathy G Supple |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134396211 PECOS PAC ID: 4486724218 Enrollment ID: I20080611000817 |
| Provider Name | Jacqueline G Walker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073563821 PECOS PAC ID: 6709949035 Enrollment ID: I20090113000781 |
| Provider Name | Thomas M Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770535973 PECOS PAC ID: 7810970738 Enrollment ID: I20110222000120 |
| Provider Name | Donald D Higgins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548211956 PECOS PAC ID: 8921081845 Enrollment ID: I20110222000474 |
| Provider Name | Eric M Spratford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245289784 PECOS PAC ID: 5193906139 Enrollment ID: I20110223000703 |
| Provider Name | Kenneth S Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700838745 PECOS PAC ID: 2264415082 Enrollment ID: I20110224000150 |
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