Portage Park Medical Group

LBN: Portage Park Medical Group
Portage Park Medical Group is an health care organization with primary practice located at 3401 N Central Ave , Chicago IL 60634-4426. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Portage Park Medical Group can be contacted via phone (773) 286-8822, or through Ansfield, Richard via phone (773) 286-8822.

Contact Information

Primary practice address
3401 N Central Ave Chicago IL 60634-4426
Phone: (773) 286-8822
Fax: (773) 824-4997
Website:
Map and Directions
Authorized official contact:
Name: Ansfield, Richard
Phone: (773) 286-8822

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1184672966
LBN Legal business name Portage Park Medical Group
DBA Doing business as
Authorized official Ansfield, Richard
Entity Organization
Organization subpart 1 No
Enumeration date May 4th, 2006
Last updated Aug 22nd, 2020 - about 5 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 1184672966 NPPES
Illinois Other 01635515 BLUE CROSS #

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