Provider Demographics
NPI:1114106978
Name:OSAFO HEALTH CARE CLINIC INC
Entity Type:Organization
Organization Name:OSAFO HEALTH CARE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSAFO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-690-3369
Mailing Address - Street 1:1107 W CAYMAN CV
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-4301
Mailing Address - Country:US
Mailing Address - Phone:309-690-3369
Mailing Address - Fax:309-683-8565
Practice Address - Street 1:303 QUADRANGLE DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3409
Practice Address - Country:US
Practice Address - Phone:630-771-1070
Practice Address - Fax:630-771-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care