Provider Demographics
NPI:1851670566
Name:PREMIERE GENERAL MEDICINE S C
Entity Type:Organization
Organization Name:PREMIERE GENERAL MEDICINE S C
Other - Org Name:NICHOLAS RIZZO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-334-7929
Mailing Address - Street 1:7270 W. COLLEGE DRIVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1180
Mailing Address - Country:US
Mailing Address - Phone:708-603-5980
Mailing Address - Fax:708-589-9059
Practice Address - Street 1:7270 W. COLLEGE DRIVE STE. 102
Practice Address - Street 2:PREMIERE GENERAL MEDICINE SC
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1180
Practice Address - Country:US
Practice Address - Phone:708-603-5980
Practice Address - Fax:708-589-9059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty