| Organization Name: | PHYSICIANS COMMUNITY MEDICAL CENTER OAK FOREST, S.C. |
| NPI Number: | 1992088157 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHERISE ELMORE (CREDENTIALING SPECIALIST) |
| Mailing Address: | 5320 159th St Ste 203 Oak Forest |
| State: | IL US |
| Postal Code: | 604523330 |
| Phone Number: | 7087988112 |
| Fax Number: | 7085356396 |
| NPI Enumeration Date: | 09/23/2011 |
| NPI Last Update Date: | 09/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |