Organization
PRIMECARE COMMUNITY HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH MOLDOVAN (CHIEF FINANCIAL OFFICER)
(312) 491-5034
Entity
Organization
Contact information
Practice address
1431 N WESTERN AVE, STE 406, CHICAGO, IL 60622-1797
(312) 633-5841
(312) 491-5020
Mailing address
2232 N CLYBOURN AVE FL 3, CHICAGO, IL 60614-3193
(312) 633-5841
(773) 269-5500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/17/2005
Last updated
10/26/2017
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