Provider Demographics
NPI:1659508356
Name:PRIMECARE MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL ASSOCIATES, INC
Other - Org Name:ENGLEWOOD IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-224-4800
Mailing Address - Street 1:1375 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5166
Mailing Address - Country:US
Mailing Address - Phone:847-891-6850
Mailing Address - Fax:630-339-5803
Practice Address - Street 1:7114 S VINCENNES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3506
Practice Address - Country:US
Practice Address - Phone:773-224-4800
Practice Address - Fax:847-890-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty