ALTAGRACIA CLINIC SC NPI 1578643755

NPI Information

NPI: 1578643755
Provider Name: ALTAGRACIA CLINIC SC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Doing Business As: ALTAGRACIA MEDICAL CENTER
CLIA Number: 14D0985761
Address: 3754 W IRVING PARK RD
CHICAGO, IL
ZIP 60618
Phone: (773) 509-1467

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NPI Details

ALTAGRACIA CLINIC SC is a family medicine in Chicago, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ALTAGRACIA CLINIC SC NPI is 1578643755. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Altagracia Medical Center.

The provider's business location address is:

3754 W IRVING PARK RD
CHICAGO, IL
ZIP 60618
Phone: (773) 509-1467
Fax: (773) 509-1695

The provider's authorized official is Ghassan D Aswad .
The authorized official title is Ceo and has the following contact phone number (773) 509-1467.

The CLIA number assigned to this NPI record is 14D0985761 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 8/22/2020.

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	207Q00000X	Family Medicine				Yes
2	208000000X	Pediatrics			ILLINOIS	X

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	1629946	OTHER	ILLINOIS	B/C B/S

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: 3/30/2025

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