Provider Demographics
NPI:1508633074
Name:LAKE COUNTY IMMEDIATE CARE, LLC
Entity Type:Organization
Organization Name:LAKE COUNTY IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:JURICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-263-3486
Mailing Address - Street 1:1849 GREEN BAY RD STE 171
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3152
Mailing Address - Country:US
Mailing Address - Phone:847-901-8400
Mailing Address - Fax:847-901-8410
Practice Address - Street 1:1849 GREEN BAY RD STE 171
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3152
Practice Address - Country:US
Practice Address - Phone:847-901-8400
Practice Address - Fax:847-901-8410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY IMMEDIATE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care