| Community Family Medicine Ltd | |
|
6307 S Stewart Ave Ste 310 Chicago IL 60621-3116 | |
| (773) 487-3017 | |
| (773) 487-3028 |
| Full Name | Community Family Medicine Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 6307 S Stewart Ave Ste 310, Chicago, Illinois |
| Authorized Official Name and Position | Edith Chaffin (OWNER/PRESIDENT) |
| Authorized Official Contact | 7734873017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Family Medicine Ltd 6307 S Stewart Ave Ste 310 Chicago IL 60621-3116 Ph: (773) 487-3017 | Community Family Medicine Ltd 6307 S Stewart Ave Ste 310 Chicago IL 60621-3116 Ph: (773) 487-3017 |
| NPI Number | 1316123961 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 06/03/2020 |
| Medicare PECOS PAC ID | 2860561347 |
|---|---|
| Medicare Enrollment ID | O20080523000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316123961 | NPI | - | NPPES |
| 1306899216 | Other | IL | PROVIDER NPI |
| 036067419 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036067419 (Illinois) | Primary |
| Provider Name | Edith M Chaffin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306899216 PECOS PAC ID: 8325117898 Enrollment ID: I20080523000351 |
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