Provider Demographics
NPI:1821359464
Name:BOLLINGBROOK URGENT CARE S.C
Entity Type:Organization
Organization Name:BOLLINGBROOK URGENT CARE S.C
Other - Org Name:BOLINGBROOK IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-430-3892
Mailing Address - Street 1:148 S BOLINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2852
Mailing Address - Country:US
Mailing Address - Phone:630-914-5373
Mailing Address - Fax:630-410-8528
Practice Address - Street 1:148 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2852
Practice Address - Country:US
Practice Address - Phone:630-914-5373
Practice Address - Fax:630-410-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084178261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care