# JOVIVE HEALTH - ILLINOIS PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568132488
- **Authorized official:** THEOPHILE G. KOURY MD (ADMIN VICE PRESIDENT OF OPERATIONS)
- **Authorized official phone:** (510) 350-2600

## Contact information

- **Practice address:** 601 E ROOSEVELT RD, LOMBARD, IL 60148-4740
- **Practice address phone:** (312) 858-5112
- **Mailing address:** 2100 POWELL ST STE 400, EMERYVILLE, CA 94608-1826
- **Mailing address phone:** (510) 350-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/14/2021
- **Last updated:** 03/17/2022