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Organization
CENTEGRA PRIMARY CARE, LLC
Active
Organization
CENTEGRA PRIMARY CARE, LLC
Active
Other names
Centegra Physician Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID TOMLINSON (CIO & CFO)
(815) 788-5831
Entity
Organization
Contact information
Practice address
13707 W JACKSON ST, WOODSTOCK, IL 60098-3188
(815) 337-2890
(815) 338-6297
Mailing address
13707 W JACKSON ST, CENTEGRA PRIMARY CARE, LLC, WOODSTOCK, IL 60098-0000
(815) 206-1060
(815) 338-6297
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209584
MEDICARE GROUP
IL
01
—
CC7412
MEDICARE RAILROAD
IL
Enumeration date
03/28/2007
Last updated
03/21/2014
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