Provider Demographics
NPI:1346423399
Name:SPS FAMILY CARE, S.C.
Entity Type:Organization
Organization Name:SPS FAMILY CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:SORVEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-619-0127
Mailing Address - Street 1:750 PEARSON ST
Mailing Address - Street 2:507
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9211
Mailing Address - Country:US
Mailing Address - Phone:773-619-0127
Mailing Address - Fax:847-635-2002
Practice Address - Street 1:1810 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5512
Practice Address - Country:US
Practice Address - Phone:773-489-6100
Practice Address - Fax:773-489-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118602261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care