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Contact Information

ELEMENTAL MEDICAL CENTER LTD
612 S WESTERN AVE APT 1
CHICAGO, IL60612-4682
 Phone: 331-330-9955
 Fax: 708-892-2909
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Mental Health (Including Community Mental Health Center)

261QM0801X B4[14] Community Mental Health Center
Indicates primary specialty

NPI Profile & details for ELEMENTAL MEDICAL CENTER LTD

NPI # 1164935169
LBN Legal business name ELEMENTAL MEDICAL CENTER LTD
Authorized official MARTINS ADEOYE - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 11/13/2017
Last updated 10/22/2024 - More than a year ago
Identifiers
IL License # 036103889
IL Medicaid 036103889
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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