Provider Demographics
NPI:1972761443
Name:PRIMECARE MEDICAR SERVIVES INC.
Entity type:Organization
Organization Name:PRIMECARE MEDICAR SERVIVES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EJOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-465-3534
Mailing Address - Street 1:6417 N RAVENSWOOD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3936
Mailing Address - Country:US
Mailing Address - Phone:773-465-3534
Mailing Address - Fax:773-465-8580
Practice Address - Street 1:6417 N RAVENSWOOD AVE STE 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3936
Practice Address - Country:US
Practice Address - Phone:773-465-3534
Practice Address - Fax:773-465-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid