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General NPI Number Information
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NPI Number | 1477848521
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Entity Type | Organization
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Legal Business Name | PRINCETON PROMPT CARE LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 2128 NORTH MAIN STREET
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City | PRINCETON
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State | IL
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Zip | 61356
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Country | US
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Telephone | 815-875-2273
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Fax | 815-664-3490
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Provider Business Mailing Address
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Address Line | 2128 NORTH MAIN STREET
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City | PRINCETON
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State | IL
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Zip | 61356
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Country | US
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Telephone | 815-875-2273
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Fax | 815-664-3490
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PAUL HERMAN BONUCCI
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Credential | MD
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Telephone | 815-875-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 036100221
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 248.000409
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License Number State | IL
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