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NPI Code Detail

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC

MEDICARE: JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC
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
1332900000XNon-Pharmacy Dispensing Site036.131322IL
2174400000XSpecialist036.131322IL

General Provider Information

NPI Number : 1639417496
Entity Type Code : Organization
Provider Name (Legal Business Name) : JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 305-628-6117
Fax Number : 305-650-0674
Provider Business Practice Location Address
First Line : 2734 W 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60652-3937
Country : US
Telephone Number : 305-628-6117
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MARY CHEN
Credential :
Telephone Number : 305-831-4722
Provider Enumeration Date : 01/29/2013
Last Update Date : 10/31/2024

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Directions to “JENCARE NEIGHBORHOOD MEDICAL CENTER EVERGREEN PARK, LLC ” Practice Location

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