MEDICARE: PRIMARY CARE PHYSICIANS, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		IL
2	111N00000X	Chiropractor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	123650	OTHER	IL	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1366465213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE PHYSICIANS, S.C.

Provider Business Mailing Address
First Line	:	3701 E LAKE CTR
Second Line	:	SUITE 1
City	:	QUINCY
State	:	IL
Zip	:	62305-5842
Country	:	US
Telephone Number	:	217-224-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 E LAKE CTR
Second Line	:	SUITE 1
City	:	QUINCY
State	:	IL
Zip	:	62305-5842
Country	:	US
Telephone Number	:	217-224-3935
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. TERRY WILLIAM SHAW
Credential	:	D.C.
Telephone Number	:	217-224-3935

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/10/2008

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Practice Location Address:

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1083736235 — GINA BRUNETTI MILLER MS, LCSW
Practice Location Address:

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Practice Location Address:

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