Provider Demographics
NPI:1487058731
Name:ENCINAS MEDICAL CENTER
Entity type:Organization
Organization Name:ENCINAS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ENCINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-888-2560
Mailing Address - Street 1:3926 W TOUHY AVE
Mailing Address - Street 2:SUITE 332
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1028
Mailing Address - Country:US
Mailing Address - Phone:773-888-2560
Mailing Address - Fax:773-345-2560
Practice Address - Street 1:4614 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3251
Practice Address - Country:US
Practice Address - Phone:773-888-2560
Practice Address - Fax:773-345-2560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-620315261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care