New Life Pentecostal Medical Clinic for the Uninsured Inc

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

036.124389 Issued in IL

Legal business name

NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED INC

Practice address

183 N Schuyler Ave
Kankakee, IL 60901-3828

Phone

(815) 304-4305

Fax

(815) 304-4306

NPI assigned

May 10, 2011

Organization subpart

No

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

Authorized official

Name

Omar Garcia, M.D.

Title

Medical Director

Phone

(815) 304-4305

Specialties & licenses 1

Addresses

Other names 1

• New Life Pentecostal Medical Clinic for the Uninsured Doing business as

Locations

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

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337212800000",
    "number": "1609168657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 N SCHUYLER AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013828",
            "telephone_number": "815-304-4305",
            "fax_number": "815-304-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 N SCHUYLER AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013828",
            "telephone_number": "815-304-4305",
            "fax_number": "815-304-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-10",
        "last_updated": "2012-05-17",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "815-304-4305",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": "036.124389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Life Pentecostal Medical Clinic for the Uninsured",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Occupational Medicine Physician in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Occupational Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2012; 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.