Provider Demographics
NPI:1639953342
Name:PALOS URGENT CARE PLLC
Entity Type:Organization
Organization Name:PALOS URGENT CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-335-6515
Mailing Address - Street 1:106 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1948
Mailing Address - Country:US
Mailing Address - Phone:732-335-6515
Mailing Address - Fax:732-305-8026
Practice Address - Street 1:10384 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465
Practice Address - Country:US
Practice Address - Phone:732-335-6515
Practice Address - Fax:732-305-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care