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NPI Code Detail

MEDICARE: PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, S.C.

MEDICARE: PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, 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
1261QM1300XMulti-Specialty Clinic/CenterIL

General Provider Information

NPI Number : 1689904039
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, S.C.
Provider Business Mailing Address
First Line : PO BOX 56590
Second Line :
City : CHICAGO
State : IL
Zip : 60656-0590
Country : US
Telephone Number : 773-878-3674
Fax Number :
Provider Business Practice Location Address
First Line : 1719 W 18TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1913
Country : US
Telephone Number : 312-421-7010
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : PETER PAPADOPOULOS
Credential :
Telephone Number : 773-878-3674
Provider Enumeration Date : 01/07/2010
Last Update Date : 01/07/2010

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Directions to “PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, S.C. ” Practice Location

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