NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED INC (NPI# 1609168657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609168657 |
| Entity Type | Organization |
| Organization Name | NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED INC |
| Other Organization Name | NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED |
| Practice Address |
183 N Schuyler Ave Kankakee IL 60901-3828 |
| Practice Telephone | 8153044305 |
| Practice Fax Number | 8153044306 |
| Mailing Telephone | 8153044305 |
| Mailing Fax Number | 8153044306 |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2012-05-17 |
| Authorized Official Name | OMAR GARCIA (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8153044305 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
036.124389 | IL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| New Life Pentecostal Medical Clinic for the Uninsured | Doing Business As Name - Organization |
| Street Address |
183 N SCHUYLER AVE |
| City | KANKAKEE |
| State | IL |
| Zip Code | 60901-3828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558978841 | William Mitsos Dds | Dentist | 1291 S. 7th Ave, Kankakee, IL 60901 | 2020-09-30 |
| 1922653682 | Jody Mcguyer, Lcpc, Cadc Counseling Services, LLC | Counselor | 315 W. Court St., Kankakee, IL 60901 | 2019-08-08 |
| 1700346327 | Sarah Elizabeth Toma | Speech-Language Pathologist | 200 E Court St #708, Kankakee, IL 60901 | 2019-03-20 |
| 1710473160 | Small Talk Speech Services, LLC | Clinic/Center | 1439 W Vanmeter St, Kankakee, IL 60901 | 2018-07-09 |
| 1124538004 | Amy J Green | Physical Therapist | 350 N. Wall Street, Kankakee, IL 60901 | 2017-10-05 |
| 1013457514 | Elizabeth Ann Smith | Registered Nurse | 292 Charlton Lane, Kankakee, IL 60901 | 2017-03-02 |
| 1861931461 | Stacey E. Brown | Nurse Practitioner | 207 N. Schuyler Ave., Kankakee, IL 60901 | 2017-02-15 |
| 1417352105 | Provider Healthcare Services, Inc | Home Health | 555 South Schuyler, Suite 275, Kankakee, IL 60901 | 2014-10-24 |
| 1265850655 | Ronald George Testa | Dentist | 202 N. Schuyler Ave, Kankakee, IL 60901 | 2014-04-02 |
| 1245587898 | Mary Beth Wertz | Registered Nurse | 100 N Jeffery Street, Kankakee, IL 60901 | 2012-08-13 |
| Find all providers in zip 60901 | ||||
| Taxonomy Code | 2083X0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Occupational Medicine |
| Occupational medicine focuses on the health of workers, including the ability to perform work; the physical, chemical, biological, and social environments of the workplace; and the health outcomes of environmental exposures. Practitioners in this field address the promotion of health in the work place, and the prevention and management of occupational and environmental injury, illness, and disability. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356816466 | Taylor Nicole Rich | Preventive Medicine | 2408 Hampshire Dr Apt 2, Champaign, IL 61820-1215 | 2018-10-05 |
| 1720517568 | Avrom Simon | Preventive Medicine | 128 S Aberdeen St Unit 5s, Chicago, IL 60607-1507 | 2017-06-06 |
| 1215332531 | Cheryl Culberson | Preventive Medicine | 350 Surryse Rd Ste 110, Lake Zurich, IL 60047-3217 | 2014-10-29 |
| 1497018493 | Brian Charles Svazas | Preventive Medicine | 211 Kenilworth Ave, Glen Ellyn, IL 60137-5324 | 2012-06-25 |
| 1205129764 | Zbigniev Durlak | Preventive Medicine | 9930 Stratford L, Palos Hills, IL 60465 | 2011-05-17 |
| 1821305269 | Daniel Alexander Bakston | Preventive Medicine | 835 S. Wolcott Ave E-144, University of Illinois Medical Center, Chicago, IL 60612-4006 | 2010-09-07 |
| 1194951913 | Sonya Meyers | Preventive Medicine | 835 S Wolcott Ave # E144, Chicago, IL 60612-3748 | 2009-06-08 |
| 1073755021 | Afiz A. Taiwo, Md. Mph. S.c. | Preventive Medicine | 309 Pinehurst Dr, Palos Heights, IL 60463-2911 | 2009-04-06 |
| 1104077494 | William Dawson | Preventive Medicine | 700 Woodmere Ln, Glenview, IL 60025-4469 | 2008-10-04 |
| 1831389816 | Cynthia Ann Ross | Preventive Medicine | 8755 S Harlem Ave, Bridgeview, IL 60455-1905 | 2007-07-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on NEW LIFE PENTECOSTAL MEDICAL CLINIC FOR THE UNINSURED INC.
| 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.