Provider Demographics
NPI:1477848521
Name:PRINCETON PROMPT CARE LLC
Entity Type:Organization
Organization Name:PRINCETON PROMPT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:BONUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-875-2273
Mailing Address - Street 1:2128 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356
Mailing Address - Country:US
Mailing Address - Phone:815-875-2273
Mailing Address - Fax:815-664-3490
Practice Address - Street 1:2128 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-875-2273
Practice Address - Fax:815-664-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100221261QU0200X
IL248.000409261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH23412Medicare UPIN
SCAA42669326Medicare PIN