Pri-Med Medical Center S C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036085803 Issued in IL

Legal business name

PRI-MED MEDICAL CENTER S C

Practice address

10715 W 159TH St
Orland Park, IL 60467-4531

Phone

(708) 226-4961

Fax

(708) 364-9301

NPI assigned

Jun 23, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shirin Arif Khan, M.D.

Title

President

Phone

(708) 226-4961

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272067200000",
    "number": "1205097201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 527",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604640527",
            "telephone_number": "708-226-4961",
            "fax_number": "708-364-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10715 W 159TH ST",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604674531",
            "telephone_number": "708-226-4961",
            "fax_number": "708-364-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRI-MED MEDICAL CENTER S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-23",
        "last_updated": "2010-04-24",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHIRIN",
        "authorized_official_middle_name": "ARIF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-226-4961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036085803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085803",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "11023950",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.