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General NPI Number Information
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NPI Number | 1215029467
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Entity Type | Organization
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Legal Business Name | FIFTH AVE PRIMARY CARE PHYSICIANS SC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 2570 FOXFIELD RD SUITE 100
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City | ST CHARLES
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State | IL
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Zip | 60174-1406
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Country | US
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Telephone | 630-584-1950
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Fax | 630-584-8994
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Provider Business Mailing Address
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Address Line | 2570 FOXFIELD RD SUITE 100
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City | ST CHARLES
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State | IL
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Zip | 60174-1406
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Country | US
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Telephone | 630-584-1950
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Fax | 630-584-8994
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Authorized Official
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Title or Position | OWNER
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Name | DR. CATHERINE S THOMAS
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Credential | M.D.
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Telephone | 630-584-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042-003468
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License Number State | IL
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