Prime Medical Clinic S.C.

LBN: Prime Medical Clinic S.C.
Prime Medical Clinic S.C. is an health care organization with primary practice located at 3633 W Lake Ave Ste 307 , Glenview IL 60026-5803. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as the primary health care specialty. Prime Medical Clinic S.C. can be contacted via phone (847) 626-8722, or through Kociasvili, Konstantins via phone (773) 507-7434.

Contact Information

Primary practice address
3633 W Lake Ave Ste 307 Glenview IL 60026-5803
Phone: (847) 626-8722
Fax: (847) 316-9502
Website:
Map and Directions
Authorized official contact:
Name: Kociasvili, Konstantins Doctor of Medicine (MD)
Phone: (773) 507-7434

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X 036135325 Illinois

Profile Details

NPI number 1659815074
LBN Legal business name Prime Medical Clinic S.C.
DBA Doing business as
Authorized official Kociasvili, Konstantins Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 5th, 2016
Last updated Jan 13th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659815074 NPPES
Illinois MEDICAID 036135325

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