Provider Demographics
NPI:1609053297
Name:ADVANCED PRIMARY HEALTH CARE SC
Entity Type:Organization
Organization Name:ADVANCED PRIMARY HEALTH CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-362-9723
Mailing Address - Street 1:1256 WATERFORD DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-978-9777
Mailing Address - Fax:630-978-9771
Practice Address - Street 1:1256 WATERFORD DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-978-9777
Practice Address - Fax:630-978-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111540261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center