Provider Demographics
NPI:1104984848
Name:NORTHWEST PRIMARY HEALTHCARE, S.C.
Entity type:Organization
Organization Name:NORTHWEST PRIMARY HEALTHCARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:KAMHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-756-7360
Mailing Address - Street 1:509 W OLD NORTHWEST HWY
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6811
Mailing Address - Country:US
Mailing Address - Phone:847-756-7360
Mailing Address - Fax:847-277-7191
Practice Address - Street 1:509 W OLD NORTHWEST HWY
Practice Address - Street 2:SUITE 100C
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6811
Practice Address - Country:US
Practice Address - Phone:847-756-7360
Practice Address - Fax:847-277-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03695547Medicaid
IL03695547Medicaid
IL213159Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER