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General NPI Number Information
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NPI Number | 1760619571
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Entity Type | Organization
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Legal Business Name | APN FAMILY CARE
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 13303 S RIDGELAND AVE UNIT C
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1815
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Country | US
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Telephone | 708-293-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 13303 S RIDGELAND AVE UNIT C
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JACK E BEAUDOIN JR.
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Credential | NP
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Telephone | 708-293-8800
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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 | 209000346
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License Number State | IL
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