Provider Demographics
NPI:1154478766
Name:PRIMARY CARE WEST, S.C.
Entity Type:Organization
Organization Name:PRIMARY CARE WEST, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-897-9606
Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-897-9606
Mailing Address - Fax:630-897-9625
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-897-9606
Practice Address - Fax:630-897-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617613261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service