Provider Demographics
NPI:1366465213
Name:PRIMARY CARE PHYSICIANS, S.C.
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-224-3935
Mailing Address - Street 1:3701 E LAKE CTR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5842
Mailing Address - Country:US
Mailing Address - Phone:217-224-3935
Mailing Address - Fax:
Practice Address - Street 1:3701 E LAKE CTR
Practice Address - Street 2:SUITE 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5842
Practice Address - Country:US
Practice Address - Phone:217-224-3935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL123650OtherBCBS GROUP NUMBER
IL123650OtherBCBS GROUP NUMBER
IL557500Medicare PIN