MIDWAY CLINIC SC NPI 1104977446

NPI Information

  • NPI: 1104977446
  • Provider Name: MIDWAY CLINIC SC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • CLIA Number: 14D0426938
  • Address: 4940 S CICERO AVE
    CHICAGO, IL
    ZIP 60638
  • Phone: (773) 582-6800

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NPI Details

MIDWAY CLINIC SC is a clinic center in Chicago, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). MIDWAY CLINIC SC NPI is 1104977446. The provider is registered as an organization entity type.

The provider's business location address is:

4940 S CICERO AVE
CHICAGO, IL
ZIP 60638-116
Phone: (773) 582-6800
Fax: (773) 582-1380

The provider's authorized official is Viktoras Dubinskas .
The authorized official title is Director and has the following contact phone number (773) 582-6800.

The CLIA number assigned to this NPI record is 14D0426938 - industrial with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/15/2007 and was last updated on 7/28/2009.

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
1261Q00000XClinic/Center036-032688ILLINOISYes

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
1C40818MEDICARE UPINILLINOIS
2036032688MEDICAIDILLINOIS
3439350MEDICARE PINILLINOIS

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: 11/21/2025

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