| Primecare Community Health, Inc. | |
|
1431 N Western Ave Ste 406 Chicago IL 60622-1797 | |
| (312) 633-5841 | |
| (312) 491-5020 |
| Full Name | Primecare Community Health, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1431 N Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Joseph Moldovan (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3124915034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Community Health, Inc. 2232 N Clybourn Ave Fl 3 Chicago IL 60614-3193 Ph: (312) 633-5841 | Primecare Community Health, Inc. 1431 N Western Ave Ste 406 Chicago IL 60622-1797 Ph: (312) 633-5841 |
| NPI Number | 1225010911 |
|---|---|
| Provider Enumeration Date | 11/17/2005 |
| Last Update Date | 10/26/2017 |
| Medicare PECOS PAC ID | 6204722077 |
|---|---|
| Medicare Enrollment ID | O20070111000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225010911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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