Provider Demographics
NPI:1790247476
Name:PRIMECARE COMMUNITY HEALTH INC.
Entity Type:Organization
Organization Name:PRIMECARE COMMUNITY HEALTH INC.
Other - Org Name:PRIMECARE BELMONT CRAGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VANGILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-491-5034
Mailing Address - Street 1:PO BOX 21844
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:312-491-5034
Mailing Address - Fax:312-491-5485
Practice Address - Street 1:5635 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4384
Practice Address - Country:US
Practice Address - Phone:773-736-1830
Practice Address - Fax:773-736-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)