Provider Demographics
NPI:1992088157
Name:PHYSICIANS COMMUNITY MEDICAL CENTER OAK FOREST, S.C.
Entity type:Organization
Organization Name:PHYSICIANS COMMUNITY MEDICAL CENTER OAK FOREST, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-798-8112
Mailing Address - Street 1:5320 159TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3334
Mailing Address - Country:US
Mailing Address - Phone:708-798-8112
Mailing Address - Fax:708-535-6396
Practice Address - Street 1:5320 159TH ST STE 203
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3330
Practice Address - Country:US
Practice Address - Phone:708-798-8112
Practice Address - Fax:708-535-6396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty