Provider Demographics
NPI:1528046323
Name:PHYSICIANS IMMEDIATE CARE LTD
Entity type:Organization
Organization Name:PHYSICIANS IMMEDIATE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-430-8600
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:
Practice Address - Street 1:3475 S ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2604
Practice Address - Country:US
Practice Address - Phone:815-874-8000
Practice Address - Fax:815-874-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0739240005Medicare NSC
IL0739240004Medicare NSC
IL0739240001Medicare NSC
IL0739240002Medicare NSC
IL0739240003Medicare NSC