Provider Demographics
NPI:1689904039
Name:PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, S.C.
Entity Type:Organization
Organization Name:PRIME CARE MEDICAL AND PHYSICAL THERAPY CENTERS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPADOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-3674
Mailing Address - Street 1:PO BOX 56590
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-0590
Mailing Address - Country:US
Mailing Address - Phone:773-878-3674
Mailing Address - Fax:
Practice Address - Street 1:1719 W 18TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1913
Practice Address - Country:US
Practice Address - Phone:312-421-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty