1538499140 NPI number — PHYSICIANS IMMEDIATE CARE LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538499140 NPI number — PHYSICIANS IMMEDIATE CARE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS IMMEDIATE CARE LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICIANS IMMEDIATE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538499140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10100 FOREST HILLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACHESNEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61115-8234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-713-2738
Provider Business Mailing Address Fax Number:
815-986-4217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E RIVERSIDE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVES PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61111-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-633-4300
Provider Business Practice Location Address Fax Number:
815-633-2961
Provider Enumeration Date:
01/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUZZARD
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
815-713-2738

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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