Provider Demographics
NPI:1235310053
Name:ASSOCIATED PHYSICIAN MEDICAL CENTER
Entity Type:Organization
Organization Name:ASSOCIATED PHYSICIAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-931-1400
Mailing Address - Street 1:1140 N MCLEAN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1782
Mailing Address - Country:US
Mailing Address - Phone:847-931-1400
Mailing Address - Fax:847-931-2072
Practice Address - Street 1:1140 N MCLEAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1782
Practice Address - Country:US
Practice Address - Phone:847-931-1400
Practice Address - Fax:847-931-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336031070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360668701Medicaid
IL0360668701Medicaid
ILB44619Medicare UPIN