Provider Demographics
NPI:1417187675
Name:PHYSICIANS PROMPT CARE CENTERS LLC
Entity Type:Organization
Organization Name:PHYSICIANS PROMPT CARE CENTERS LLC
Other - Org Name:PROMPT CARE EXPRESS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-478-2500
Mailing Address - Street 1:9352 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5541
Mailing Address - Country:US
Mailing Address - Phone:708-478-2500
Mailing Address - Fax:
Practice Address - Street 1:9352 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5541
Practice Address - Country:US
Practice Address - Phone:708-478-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088445261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207499OtherGROUP MEDICARE