Basic Information
| Provider Information | |||||||||
| NPI: | 1649553892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS COMMUNITY MEDICAL CENTER NORTH, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5320 159TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | OAK FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604523334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087988112 | ||||||||
| FaxNumber: | 7085356396 | ||||||||
| Practice Location | |||||||||
| Address1: | 5320 159TH ST # 2N | ||||||||
| Address2: | |||||||||
| City: | OAK FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604524705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087988112 | ||||||||
| FaxNumber: | 7085356396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2011 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | ELMORE | ||||||||
| AuthorizedOfficialFirstName: | CHERISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL BILLING MANGER | ||||||||
| AuthorizedOfficialTelephone: | 7087988112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine |
No ID Information.