Healthcare Provider Details

I. General information

NPI: 1295639912
Provider Name (Legal Business Name): PRIMECARE COMMUNITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 W CERMARK ROAD
CHICAGO IL
60608-3514
US

IV. Provider business mailing address

2211 N ELSTON AVE STE 301
CHICAGO IL
60614-9278
US

V. Phone/Fax

Practice location:
  • Phone: 312-668-8500
  • Fax:
Mailing address:
  • Phone: 312-668-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL C HOLTROP
Title or Position: CFO
Credential:
Phone: 616-482-9892