Provider Demographics
NPI:1518445675
Name:ISLAND LAKE URGENT CARE INC
Entity type:Organization
Organization Name:ISLAND LAKE URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EBIRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-433-4418
Mailing Address - Street 1:521 KORA LN
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9101
Mailing Address - Country:US
Mailing Address - Phone:847-469-6971
Mailing Address - Fax:847-469-6974
Practice Address - Street 1:521 KORA LANE
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-8438
Practice Address - Country:US
Practice Address - Phone:847-469-6971
Practice Address - Fax:847-469-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care