Organization
BLUE ISLAND CLINIC COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE T BREWER (DIRECTOR)
(615) 465-7626
Entity
Organization
Contact information
Practice address
12935 GREGORY ST, BLUE ISLAND, IL 60406-2428
(708) 597-2000
(708) 824-4494
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7632
(615) 465-2885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
363A00000X
Physician Assistant
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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