Basic Information
| Provider Information | |||||||||
| NPI: | 1285745125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELGIN FAMILY PHYSICIANS, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 N AIRLITE ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478883661 | ||||||||
| FaxNumber: | 8478889964 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 N AIRLITE ST STE 130 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478883661 | ||||||||
| FaxNumber: | 8478889964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8478883661 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 042006899 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 951280 | 01 | MEDICARE GROUP NUMBER | OTHER |