Provider Demographics
NPI:1508752247
Name:DR PRICE MEDICAL SC
Entity type:Organization
Organization Name:DR PRICE MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:443-602-6260
Mailing Address - Street 1:2631 W JEROME ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1407
Mailing Address - Country:US
Mailing Address - Phone:443-602-6260
Mailing Address - Fax:
Practice Address - Street 1:6212 N LINCOLN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2200
Practice Address - Country:US
Practice Address - Phone:443-602-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208701064001Medicaid