Provider Demographics
NPI:1063841393
Name:SCHAUMBURG PRIMARY MEDICAL CENTER
Entity Type:Organization
Organization Name:SCHAUMBURG PRIMARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL MGR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-891-6850
Mailing Address - Street 1:2200 S MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5334
Mailing Address - Country:US
Mailing Address - Phone:773-744-7864
Mailing Address - Fax:
Practice Address - Street 1:2200 S MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5334
Practice Address - Country:US
Practice Address - Phone:773-744-7864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty