Provider Demographics
NPI:1255834446
Name:ILLINOIS PRIMARY URGENT CARE LLC
Entity Type:Organization
Organization Name:ILLINOIS PRIMARY URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:WAHID
Authorized Official - Last Name:ROYEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-337-0736
Mailing Address - Street 1:2026 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:61462-9054
Mailing Address - Country:US
Mailing Address - Phone:309-337-0736
Mailing Address - Fax:
Practice Address - Street 1:1201 E BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:IL
Practice Address - Zip Code:61462-1995
Practice Address - Country:US
Practice Address - Phone:309-337-0736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127590261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care