Provider Demographics
NPI:1568777845
Name:INSTANT CARE MEDICAL GROUP SC
Entity Type:Organization
Organization Name:INSTANT CARE MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-869-9700
Mailing Address - Street 1:815 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3916
Mailing Address - Country:US
Mailing Address - Phone:847-869-9700
Mailing Address - Fax:847-869-7979
Practice Address - Street 1:815 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3916
Practice Address - Country:US
Practice Address - Phone:847-869-9700
Practice Address - Fax:847-869-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty