Provider Demographics
NPI:1902173826
Name:MEDICAL CENTER OF DYER, LTD
Entity Type:Organization
Organization Name:MEDICAL CENTER OF DYER, LTD
Other - Org Name:FIRST CHOICE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-655-1489
Mailing Address - Street 1:11164 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2709
Mailing Address - Country:US
Mailing Address - Phone:708-907-3422
Mailing Address - Fax:708-249-6775
Practice Address - Street 1:11164 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2709
Practice Address - Country:US
Practice Address - Phone:708-907-3422
Practice Address - Fax:708-249-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1891769303Medicaid