Provider Demographics
NPI:1275779407
Name:ELMHURST MEMORIAL AFFILIATED PRIMARY CARE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:ELMHURST MEMORIAL AFFILIATED PRIMARY CARE PHYSICIANS, LLC
Other - Org Name:PRIMARY CARE ASSOICATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-758-9923
Mailing Address - Street 1:455 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2003
Mailing Address - Country:US
Mailing Address - Phone:630-834-0400
Mailing Address - Fax:
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-681-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center