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Organization
PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Active
Organization
PRIMESOURCE HEALTHCARE SYSTEMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID FLEMING (PRESIDENT & CEO)
(800) 317-0711
Entity
Organization
Contact information
Practice address
2100 EAST LAKE COOK ROAD, SUITE 1100, BUFFALO GROVE, IL 60089-1815
(800) 317-0711
(877) 821-6402
Mailing address
2100 EAST LAKE COOK ROAD, SUITE 1100, BUFFALO GROVE, IL 60089-1815
(800) 317-0711
(877) 821-6402
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
152W00000X
Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
213E00000X
Podiatrist
Primary
—
—
231H00000X
Audiologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175113
ANTHEM
IN
05
—
100052700
—
IN
05
—
200109050
—
IN
05
—
200378850A
—
IN
Enumeration date
05/09/2006
Last updated
02/19/2014
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