Provider Demographics
NPI:1225122344
Name:MEDCOR OF BARRINGTON, PC
Entity Type:Organization
Organization Name:MEDCOR OF BARRINGTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLIMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-363-9500
Mailing Address - Street 1:PO BOX 92170
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60009-2170
Mailing Address - Country:US
Mailing Address - Phone:815-363-9500
Mailing Address - Fax:815-363-3357
Practice Address - Street 1:4805 PRIME PKWY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7002
Practice Address - Country:US
Practice Address - Phone:815-363-9500
Practice Address - Fax:815-363-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9592Medicare PIN