Basic Information
| Provider Information | |||||||||
| NPI: | 1417990219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY ROOM CARE PROVIDERS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | EMERGENCY ROOM CARE PROVIDERS, S.C. | ||||||||
| Address2: | DEPT 4034, PO BOX 3065 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605223065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728800 | ||||||||
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| Practice Location | |||||||||
| Address1: | JACKSON PARK HOSPITAL | ||||||||
| Address2: | 7531 S. STONY ISLAND AVE | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606493954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739477500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | WAKIM | ||||||||
| AuthorizedOfficialFirstName: | PIERRE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304728800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036082409 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.