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 |