Provider Demographics
NPI:1780830323
Name:PROCARE MEDICAL CENTER OF OAK PARK S.C.
Entity Type:Organization
Organization Name:PROCARE MEDICAL CENTER OF OAK PARK S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-386-9600
Mailing Address - Street 1:6715 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1006
Mailing Address - Country:US
Mailing Address - Phone:708-386-9600
Mailing Address - Fax:708-386-6558
Practice Address - Street 1:6715 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1006
Practice Address - Country:US
Practice Address - Phone:708-386-9600
Practice Address - Fax:708-386-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094250Medicaid
IL574330Medicare PIN
ILG70107Medicare UPIN