Provider Demographics
NPI:1205097201
Name:PRI-MED MEDICAL CENTER S C
Entity type:Organization
Organization Name:PRI-MED MEDICAL CENTER S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:ARIF
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-226-4961
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-0527
Mailing Address - Country:US
Mailing Address - Phone:708-226-4961
Mailing Address - Fax:708-364-9301
Practice Address - Street 1:10715 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4531
Practice Address - Country:US
Practice Address - Phone:708-226-4961
Practice Address - Fax:708-364-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085803Medicaid
IL11023950OtherMEDICARE RAILROAD
IL202383Medicare PIN
IL11023950OtherMEDICARE RAILROAD