FULLERTON KIMBALL MEDICAL GROUP SC; NPI #1831213081

Contact Information

FULLERTON KIMBALL MEDICAL GROUP SC

3412 W FULLERTON AVE
CHICAGO, IL 60647-2416

Phone: 773-235-8000
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Multi-Specialty	261QM1300X	70	Clinic or Group Practice

Indicates primary specialty

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NPI Profile & details for FULLERTON KIMBALL MEDICAL GROUP SC

NPI # 1831213081

LBN Legal business name FULLERTON KIMBALL MEDICAL GROUP SC

Authorized official RENLIN XIA - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 03/16/2007

Last updated 08/24/2023 - About 3 years ago

Identifiers

IL	Medicaid	036088691 4
IL	Other	01635426	BCBS GROUP

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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