| Rogers Park Family Medicine, Sc. | |
|
2306 W Touhy Ave # C1 Chicago IL 60645-3414 | |
| (773) 262-7000 | |
| (773) 262-7002 |
| Full Name | Rogers Park Family Medicine, Sc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2306 W Touhy Ave # C1, Chicago, Illinois |
| Authorized Official Name and Position | James P Clancy (PRESIDENT) |
| Authorized Official Contact | 7732627000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rogers Park Family Medicine, Sc. 2306 W Touhy Ave Ste C1 Chicago IL 60645-3473 Ph: (773) 262-7000 | Rogers Park Family Medicine, Sc. 2306 W Touhy Ave # C1 Chicago IL 60645-3414 Ph: (773) 262-7000 |
| NPI Number | 1740391549 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 10/10/2014 |
| Medicare PECOS PAC ID | 7315943750 |
|---|---|
| Medicare Enrollment ID | O20061009000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740391549 | NPI | - | NPPES |
| 01636575 | Other | IL | BLUE CROSS BLUE SHIELD |
| 036096295 | Medicaid | IL | |
| 214060 | Other | IL | MEDICARE PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036096295 (Illinois) | Primary |
| Provider Name | James P Clancy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538162102 PECOS PAC ID: 5496751836 Enrollment ID: I20061009000217 |
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