| Fox Ridge Medical Associates, Llc | |
|
3633 Municipal Dr Mchenry IL 60050 | |
| (815) 861-5543 | |
| Not Available |
| Full Name | Fox Ridge Medical Associates, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3633 Municipal Dr, Mchenry, Illinois |
| Authorized Official Name and Position | Jeffrey Scott Tomlin (PRACTICE OWNER) |
| Authorized Official Contact | 8158615543 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox Ridge Medical Associates, Llc 3633 Municipal Dr Mchenry IL 60050-5434 Ph: (779) 244-3072 | Fox Ridge Medical Associates, Llc 3633 Municipal Dr Mchenry IL 60050 Ph: (815) 861-5543 |
| NPI Number | 1013402825 |
|---|---|
| Provider Enumeration Date | 06/25/2018 |
| Last Update Date | 08/28/2018 |
| Medicare PECOS PAC ID | 3779832787 |
|---|---|
| Medicare Enrollment ID | O20180824001542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013402825 | NPI | - | NPPES |
| F100494732 | Other | PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036.092485 (Illinois) | Primary |
| Provider Name | Jeffrey S Tomlin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639163850 PECOS PAC ID: 7012813413 Enrollment ID: I20040616000817 |
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