FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC NPI 1740304757

NPI Information

NPI: 1740304757
Provider Name: FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC
Classification: Clinic/Center - 261QX0100X
Entity Type: Organization

Specialization: Occupational Medicine

CLIA Number: 14D1078393

Address:
3409 W FULLERTON AVE
CHICAGO, IL
ZIP 60647
Phone: (773) 486-5001
Get Directions

FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC is an occupational medicine clinic center in Chicago, IL. FULLERTON OCCUPATIONAL MEDICINE & IMMEDIATE CARE SC NPI is 1740304757. The provider is registered as an organization entity type.

The provider's business location address is:

3409 W FULLERTON AVE
CHICAGO, IL
ZIP 60647-415
Phone: (773) 486-5001

The provider's authorized official is Renlin Xia .
The authorized official title is President and has the following contact phone number (773) 486-5001.

The CLIA number assigned to this NPI record is 14D1078393 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/16/2007 and was last updated on 4/13/2010.

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	261QP2000X	Clinic/Center	Physical Therapy	364061160	ILLINOIS	No
2	261QU0200X	Clinic/Center	Urgent Care	364061160	ILLINOIS	No
3	261QX0100X	Clinic/Center	Occupational Medicine	364061160	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	OTHER
2	036088691 4	MEDICAID	ILLINOIS
3	G21025	MEDICARE UPIN	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: 11/14/2023

NPI Synchronization or Removal

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