Healthcare Provider Details

I. General information

NPI: 1053897165
Provider Name (Legal Business Name): PREMIER HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E 47TH ST
CHICAGO IL
60653-4507
US

IV. Provider business mailing address

1301 E 47TH ST
CHICAGO IL
60653-4507
US

V. Phone/Fax

Practice location:
  • Phone: 773-643-1600
  • Fax:
Mailing address:
  • Phone: 773-891-2890
  • Fax: 773-891-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL MCGEE
Title or Position: PRESIDENT
Credential: MD
Phone: 219-730-7790