Healthcare Provider Details

I. General information

NPI: 1972761443
Provider Name (Legal Business Name): PRIMECARE MEDICAR SERVIVES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 N RAVENSWOOD AVE STE 206
CHICAGO IL
60626-3936
US

IV. Provider business mailing address

6417 N RAVENSWOOD AVE STE 206
CHICAGO IL
60626-3936
US

V. Phone/Fax

Practice location:
  • Phone: 773-465-3534
  • Fax: 773-465-8580
Mailing address:
  • Phone: 773-465-3534
  • Fax: 773-465-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. RALPH EJOH
Title or Position: PRESIDENT
Credential:
Phone: 773-465-3534