Prime Care Medical Center SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRIME CARE MEDICAL CENTER SC

Practice address

99 Boulder Hill Pass
Montgomery, IL 60538-1911

Phone

(630) 897-2848

Fax

(630) 897-4498

NPI assigned

Mar 4, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas George Tzanetakos, MD

Title

Pres Owner

Phone

(630) 897-2848

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1427228642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 BOULDER HILL PASS",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605381911",
            "telephone_number": "630-897-2848",
            "fax_number": "630-897-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 BOULDER HILL PASS",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605381911",
            "telephone_number": "630-897-2848",
            "fax_number": "630-897-4498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE MEDICAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-04",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "TZANETAKOS",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PRES OWNER",
        "authorized_official_telephone_number": "630-897-2848",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Montgomery, IL
• Providers in Montgomery, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.