Provider Demographics
NPI:1700230398
Name:PRIMECARE COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:PRIMECARE COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-491-5034
Mailing Address - Street 1:2232 N CLYBOURN AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3193
Mailing Address - Country:US
Mailing Address - Phone:312-633-5841
Mailing Address - Fax:773-269-5500
Practice Address - Street 1:1127 N OAKLEY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-633-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL781855Medicare Oscar/Certification
IL324020Medicare Oscar/Certification