ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER (NPI# 1104857341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104857341 |
| Entity Type | Organization |
| Organization Name | ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER |
| Practice Address |
9500 S Dorchester Ave Ste 100 Chicago IL 60628-1700 |
| Mailing Address |
9500 S Dorchester Ave Suite 100 Chicago IL 60628-1700 |
| Practice Telephone | 7736670768 |
| Practice Fax Number | 7736675529 |
| Mailing Telephone | 7736670768 |
| Mailing Fax Number | 7736675529 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-08-18 |
| Authorized Official Name | DR. NICOLE D. KING (OWNER) |
| Authorized Official Telephone | 7736670768 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
036096686 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | AETNA PPO | 7779286 | 01 |
| IL | CIGNA | 7455146 | 01 |
| IL | BC/BS | 1634166 | 01 |
| IL | TRICARE | 0061621 | 01 |
| IL | RAILRAOD MEDICARE | DD6694 | 01 |
| IL | AETNA HMO | 3474878 | 01 |
| Street Address |
9500 S DORCHESTER AVE STE 100 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60628-1700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558334003 | Nicole D King | Internal Medicine | 9500 S Dorchester Ave, Suite 100, Chicago, IL 60628-1700 | 2006-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750857942 | Myrna Pledger | Counselor | 259 W. 104th Pl., Chicago, IL 60628 | 2018-10-16 |
| 1073097184 | 4every1 Lab Inc. | Clinical Medical Laboratory | 10723 S Halsted St, Chicago, IL 60628 | 2018-09-24 |
| 1922594613 | Northwest Adult Wellness Center LLC | Clinic/Center | 235 W 95th Suite 3, Chicago, IL 60628 | 2018-07-05 |
| 1285152801 | Brittany Bellamy | Developmental Therapist | 10333 S Prairie, Chicago, IL 60628 | 2017-09-04 |
| 1598293839 | Denise Marie Mercherson | Social Worker | 9561 S. Union, Chicago, IL 60628 | 2017-05-31 |
| 1659821221 | Tca Health Care | Dentist | 1030 E. 130th St, Chicago, IL 60628 | 2016-10-07 |
| 1528432697 | Global Dialysis, LLC | Registered Nurse | 9746 South Harvard Ave., Chicago, IL 60628 | 2015-11-30 |
| 1871966382 | Kirby Rehabilitation, Inc | Clinic/Center | 723 W. 111th St, Chicago, IL 60628 | 2015-11-05 |
| 1851638605 | Marketa Marvanova | Pharmacist | 9501 S. King Drive, Douglas Hall 203-23, Chicago State University College of Pharmacy, Chicago, IL 60628 | 2013-01-14 |
| 1841567377 | Emma Goodman | Pharmacist | 10620 S. Halsted St, Chicago, IL 60628 | 2011-11-29 |
| Find all providers in zip 60628 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1497251037 | Thomas L Pitts, Md LLC | Clinic/Center | 233 E Erie St Ste 702, Chicago, IL 60611-5933 | 2018-04-03 |
| 1407209208 | Mount Sinai Hospital Medical Center | Clinic/Center | 1501 S California Ave # L1026, Chicago, IL 60608-1732 | 2016-07-16 |
| 1487058731 | Encinas Medical Center | Clinic/Center | 4614 S Ashland Ave, Chicago, IL 60609-3251 | 2014-10-15 |
| 1366872061 | Lawndale Christian Health Center | Clinic/Center | 5122 S Archer Ave, Chicago, IL 60632-4508 | 2013-11-15 |
| 1083051643 | Oak Street Health Physicians Group, PC | Clinic/Center | 30 W Monroe St Ste 1200, Chicago, IL 60603-2420 | 2013-05-22 |
| 1043564529 | Triple S Medical Care S.c. | Clinic/Center | 6455 S Pulaski Rd, Chicago, IL 60629 | 2012-11-05 |
| 1548541022 | Valentinalb,s.c. | Clinic/Center | 5108 N Lincoln Ave, Chicago, IL 60625-7295 | 2011-08-29 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.