Provider Demographics
NPI:1831239789
Name:NORTHWEST PRIMARY CARE ALLIANCE
Entity type:Organization
Organization Name:NORTHWEST PRIMARY CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IPA ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-755-3203
Mailing Address - Street 1:1786 MOON LAKE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5029
Mailing Address - Country:US
Mailing Address - Phone:847-755-3203
Mailing Address - Fax:847-755-3227
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-5029
Practice Address - Country:US
Practice Address - Phone:847-755-3203
Practice Address - Fax:847-755-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID