FULLERTON KIMBALL MEDICAL GROUP SC NPI 1831213081

NPI Information

NPI: 1831213081
Provider Name: FULLERTON KIMBALL MEDICAL GROUP SC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
3412 W FULLERTON AVE
CHICAGO, IL
ZIP 60647
Phone: (773) 235-8000
Get Directions

FULLERTON KIMBALL MEDICAL GROUP SC is a multi-specialty clinic center in Chicago, IL. FULLERTON KIMBALL MEDICAL GROUP SC NPI is 1831213081. The provider is registered as an organization entity type.

The provider's business location address is:

3412 W FULLERTON AVE
CHICAGO, IL
ZIP 60647-416
Phone: (773) 235-8000

The provider's authorized official is Renlin Xia .
The authorized official title is President and has the following contact phone number (773) 235-8000.

The enumeration date for this NPI number is 3/16/2007 and was last updated on 8/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01635426	OTHER	ILLINOIS	BCBS GROUP
2	036088691 4	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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