Fullerton Kimball Medical Group Sc

LBN: Fullerton Kimball Medical Group Sc
Fullerton Kimball Medical Group Sc is an health care organization with primary practice located at 3412 W Fullerton Ave , Chicago IL 60647-2416. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Fullerton Kimball Medical Group Sc can be contacted via phone (773) 235-8000, or through Xia, Renlin via phone (773) 235-8000.

Contact Information

Primary practice address
3412 W Fullerton Ave Chicago IL 60647-2416
Phone: (773) 235-8000
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Xia, Renlin Doctor of Medicine (MD)
Phone: (773) 235-8000

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X Illinois

Profile Details

NPI number 1831213081
LBN Legal business name Fullerton Kimball Medical Group Sc
DBA Doing business as
Authorized official Xia, Renlin Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 16th, 2007
Last updated Aug 24th, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831213081 NPPES
Illinois Other 01635426 BCBS GROUP
Illinois MEDICAID 036088691 4 BCBS GROUP

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