PARK PRIMARY CARE LTD NPI 1891984068

NPI Information

  • NPI: 1891984068
  • Provider Name: PARK PRIMARY CARE LTD
  • Classification: General Practice - 208D00000X
  • Entity Type: Organization
  • CLIA Number: 14D1047764
  • Address: 9760 S KEDZIE AVE
    SUITE 2
    EVERGREEN PARK, IL
    ZIP 60805
  • Phone: (708) 423-8150

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NPI Details

PARK PRIMARY CARE LTD is a general practice in Evergreen Park, IL. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee PARK PRIMARY CARE LTD NPI is 1891984068. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9760 S KEDZIE AVE
SUITE 2
EVERGREEN PARK, IL
ZIP 60805-109
Phone: (708) 423-8150
Fax: (708) 423-8152

The provider's authorized official is George Thomas .
The authorized official title is Owner and has the following contact phone number (708) 423-8150.

The CLIA number assigned to this NPI record is 14D1047764 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/23/2007 and was last updated on 6/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CA1215OTHERILLINOISRAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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