OrganizationGrand Medical Clinic, IncSurgeryAllopathic & Osteopathic PhysiciansPractice Address2158 W Grand Ave, Suite 101, Chicago, IL 60612-1571(312) 733-9858PECOS EnrollmentBased on the most recent information from CMS, provider Grand Medical Clinic, Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1457658841Provider TypeOrganizationFull NameGrand Medical Clinic, IncSubpartNoEnumeration Date2/21/2011Last Updated2/21/2011Contact InformationPractice LocationPractice Address2158 W Grand Ave, Suite 101, Chicago, IL 60612-1571Phone(312) 733-9858Fax(312) 799-8661Mailing LocationMailing Address2158 W Grand Ave, Suite 101, Chicago, IL 60612-1571Phone(312) 733-9858Fax(312) 799-8661Authorized OfficialNameGarcia, Omar (Owner)Phone(312) 733-9858Provider TaxonomiesCodeDescriptionLicenseCode208600000XPrimaryDescriptionSurgeryAllopathic & Osteopathic PhysiciansLicense036124389Illinois