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General NPI Number Information
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NPI Number | 1609595966
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Entity Type | Organization
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Legal Business Name | SIMPLE PRIMARY CARE LLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 2340 S HIGHLAND AVE STE 270
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City | LOMBARD
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State | IL
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Zip | 60148-5396
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Country | US
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Telephone | 630-755-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 S HIGHLAND AVE STE 270
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City | LOMBARD
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State | IL
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Zip | 60148-5396
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Country | US
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Telephone | 630-755-5881
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | UZMA SHAMSI
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Credential | NP
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Telephone | 630-776-0856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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