Provider Demographics
NPI:1063844934
Name:PRIMARY HEALTHCARE ASSOCIATES, SC
Entity Type:Organization
Organization Name:PRIMARY HEALTHCARE ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORFIRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-915-6314
Mailing Address - Street 1:6701 159TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1758
Mailing Address - Country:US
Mailing Address - Phone:708-915-6314
Mailing Address - Fax:708-915-2706
Practice Address - Street 1:6701 159TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1758
Practice Address - Country:US
Practice Address - Phone:708-915-6314
Practice Address - Fax:708-915-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047581332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site