| Premier Primary Care And Alternative Medicine | |
|
1301 E 47th Street Bldg 2 Suite B Chicago IL 60653 | |
| (773) 891-2890 | |
| (773) 891-4107 |
| Full Name | Premier Primary Care And Alternative Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1301 E 47th Street, Chicago, Illinois |
| Authorized Official Name and Position | Reuben C Rutland (CHIEF OPERATION OFFICER) |
| Authorized Official Contact | 5742767184 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Primary Care And Alternative Medicine 1301 E 47th Street Bldg 2 Suite B Chicago IL 60653 Ph: (773) 891-2890 | Premier Primary Care And Alternative Medicine 1301 E 47th Street Bldg 2 Suite B Chicago IL 60653 Ph: (773) 891-2890 |
| NPI Number | 1003406000 |
|---|---|
| Provider Enumeration Date | 01/22/2021 |
| Last Update Date | 06/28/2021 |
| Medicare PECOS PAC ID | 1850794744 |
|---|---|
| Medicare Enrollment ID | O20210729003121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003406000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Audrey L Tanksley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750524518 PECOS PAC ID: 8123277431 Enrollment ID: I20121002000288 |
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