Provider Demographics
NPI:1447283569
Name:EPIC GROUP-EMERGENCY PHYSICIANS AN ILLINOIS CONCERN S.C.
Entity type:Organization
Organization Name:EPIC GROUP-EMERGENCY PHYSICIANS AN ILLINOIS CONCERN S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-691-1253
Mailing Address - Street 1:PO BOX 4777
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-4777
Mailing Address - Country:US
Mailing Address - Phone:866-898-7147
Mailing Address - Fax:
Practice Address - Street 1:150 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1463
Practice Address - Country:US
Practice Address - Phone:815-942-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCG0558OtherRAILROAD MEDICARE
IL03223219OtherBLUE CROSS BLUE SHIELD
ILCG0558OtherRAILROAD MEDICARE