| NPI | 1275729303 |
|---|---|
| Doing Business As | SOUTHCARE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | PETER F MACENTEE President 773-779-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: IL 036072512) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: IL 036047977) |
| 305S00000X Point of Service (Licence: IL 036063080) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2011-03-08 |