| Primecare Fullerton | |
|
3924 W Fullerton Ave Chicago IL 60647-2228 | |
| (773) 276-2229 | |
| (773) 276-2190 |
| Full Name | Primecare Fullerton |
|---|---|
| Speciality | Clinic/Center |
| Location | 3924 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | Joseph Moldovan (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3124915034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primecare Fullerton 1431 N. Western Ave. Suite #401 Chicago IL 60622-1797 Ph: (312) 633-5841 | Primecare Fullerton 3924 W Fullerton Ave Chicago IL 60647-2228 Ph: (773) 276-2229 |
| NPI Number | 1992851067 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 10/26/2017 |
| Medicare PECOS PAC ID | 6204722077 |
|---|---|
| Medicare Enrollment ID | O20070111000413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992851067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
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