Healthcare Provider Details

I. General information

NPI: 1750746681
Provider Name (Legal Business Name): SOUTHWEST URGENT CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 W 95TH ST
EVERGREEN PARK IL
60805-2409
US

IV. Provider business mailing address

8790 W 103RD ST
PALOS HILLS IL
60465-1603
US

V. Phone/Fax

Practice location:
  • Phone: 708-200-6615
  • Fax: 708-598-3304
Mailing address:
  • Phone: 708-200-6615
  • Fax: 708-598-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HANAN YOUSIF
Title or Position: PRESIDENT
Credential:
Phone: 708-200-6615