| Rudyard Smith Md And Associates Sc | |
|
1514 E 87th St Chicago IL 60619-6525 | |
| (773) 978-0757 | |
| (773) 978-0705 |
| Full Name | Rudyard Smith Md And Associates Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1514 E 87th St, Chicago, Illinois |
| Authorized Official Name and Position | Rudyard U Smith (PRESIDENT) |
| Authorized Official Contact | 7739780757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rudyard Smith Md And Associates Sc 7906 S Crandon Ave Chicago IL 60617-1146 Ph: (773) 978-0757 | Rudyard Smith Md And Associates Sc 1514 E 87th St Chicago IL 60619-6525 Ph: (773) 978-0757 |
| NPI Number | 1588607345 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 08/12/2021 |
| Medicare PECOS PAC ID | 2567360803 |
|---|---|
| Medicare Enrollment ID | O20050929000782 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588607345 | NPI | - | NPPES |
| 036053241001 | Medicaid | IL | |
| 110233216 | Other | IL | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036053241 (Illinois) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Rudyard U Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295784031 PECOS PAC ID: 5698673937 Enrollment ID: I20031223000793 |
| Provider Name | Whitney Mariellen Saunders-catchings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629490842 PECOS PAC ID: 1557591856 Enrollment ID: I20140306001663 |
| Provider Name | Steven Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114360013 PECOS PAC ID: 3779885975 Enrollment ID: I20160406001618 |
| Provider Name | Elaine Cabugason |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386987238 PECOS PAC ID: 0941501654 Enrollment ID: I20160818000467 |
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