Provider Demographics
NPI:1841512316
Name:TRI-CITIES IMMEDIATE CARE LLC
Entity type:Organization
Organization Name:TRI-CITIES IMMEDIATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-208-4015
Mailing Address - Street 1:815 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1992
Mailing Address - Country:US
Mailing Address - Phone:630-208-4015
Mailing Address - Fax:630-208-0942
Practice Address - Street 1:815 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1992
Practice Address - Country:US
Practice Address - Phone:630-208-4015
Practice Address - Fax:630-208-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360865376146M00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty