Healthcare Provider Details

I. General information

NPI: 1265547020
Provider Name (Legal Business Name): NATIONAL MEDICAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N CUMBERLAND AVE
NORRIDGE IL
60706-2905
US

IV. Provider business mailing address

4701 N CUMBERLAND AVE
NORRIDGE IL
60706-2905
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-0152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-9000