Provider Demographics
NPI:1700023793
Name:PRIMUS ORTHOPEDICS SC
Entity Type:Organization
Organization Name:PRIMUS ORTHOPEDICS SC
Other - Org Name:CHICAGO CENTER FOR SPORTS MEDICINE AND ORTHOPEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:PRIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-263-2000
Mailing Address - Street 1:7543 183RD ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6208
Mailing Address - Country:US
Mailing Address - Phone:708-263-2000
Mailing Address - Fax:708-263-2023
Practice Address - Street 1:7543 183RD ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6208
Practice Address - Country:US
Practice Address - Phone:708-263-2000
Practice Address - Fax:708-263-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-118611207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty