FULLERTON KIMBALL MEDICAL & SURGICAL CENTER (NPI# 1205964103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205964103 |
| Entity Type | Organization |
| Organization Name | FULLERTON KIMBALL MEDICAL & SURGICAL CENTER |
| Practice Address |
3412 W Fullerton Ave Chicago IL 60647-2416 |
| Practice Telephone | 7732358000 |
| Mailing Telephone | 7732358000 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2014-04-09 |
| Authorized Official Name | DR. RENLIN XIA (PRESIDENT) |
| Authorized Official Telephone | 7732358000 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
7003181 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | TAXONOMY CODE | 261Q00000X | 01 |
| Street Address |
3412 W FULLERTON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60647-2416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992289599 | Liauw Devi Gunawan | Nurse Practitioner | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2018-09-19 |
| 1962845289 | Integrated Pain Management Sc | Anesthesiology | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2013-04-17 |
| 1376771576 | Gregory Wells | Anesthesiology | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2009-06-25 |
| 1801914791 | Cmp Professional Services | Anesthesiology | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2007-03-27 |
| 1912021726 | Miguel Cua | Anesthesiology | 3412 W Fullerton Ave, Chicago, IL 60647 | 2007-03-19 |
| 1831213081 | Fullerton Kimball Medical Group PC | Clinic/Center | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2007-03-16 |
| 1790809960 | Renlin Xia | Anesthesiology | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2007-03-16 |
| 1861524407 | Dominador Padua Ruiz | Clinic/Center | 3412 W Fullerton Ave, Chicago, IL 60647-2416 | 2007-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164035879 | Scott Spine and Health LLC | Chiropractor | 2560 W. Armitage Ave, Unit C2, Chicago, IL 60647 | 2020-08-24 |
| 1003424458 | Emily Gleesing | Physical Therapist | 1923 N Western Ave, Chicago, IL 60647 | 2020-07-21 |
| 1699301358 | Marcella Guzman P.C. | Dentist | 3236 W. Fullerton Ave., Chicago, IL 60647 | 2020-03-13 |
| 1740772342 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 3n, Chicago, IL 60647 | 2018-05-31 |
| 1992297535 | Envision Unlimited | Case Management | 2646 N Washtenaw Ave # 2n, Chicago, IL 60647 | 2018-05-30 |
| 1942704580 | Team Rehabilitation Il15, LLC | Physical Therapist | 1923 N Western Avenue, Chicago, IL 60647 | 2018-03-20 |
| 1023517331 | Chicago Medical Healthcare Group, S.c. | Family Medicine | 3648 W Armitage Avenue, Chicago, IL 60647 | 2018-02-02 |
| 1023537693 | Erin Frommeyer | Physician Assistant | 2228 W Dickens Avenue, Chicago, IL 60647 | 2017-09-15 |
| 1457872475 | Stefanie Paola Maurtua | Behavioral Analyst | 2448 West Bloomingdale Ave., Apt 2e, Chicago, IL 60647 | 2017-06-29 |
| 1700322922 | Lumen Optical Illinois 4, LLC | Optometrist | 2420 N Elston, Bucktown, IL 60647 | 2017-01-11 |
| Find all providers in zip 60647 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487115804 | Ontario Street Operatory Fac | Clinic/Center | 22 W Ontario Street Operatory, Chicago, IL 60654 | 2019-03-28 |
| 1477017333 | Ontario Street Operatory | Clinic/Center | 22 W Ontario St, Chicago, IL 60654-5169 | 2019-01-24 |
| 1407329501 | Chicago Cosmetic Surgery Institute | Clinic/Center | 2335 S Michigan Ave, Chicago, IL 60616-2104 | 2019-01-10 |
| 1720505787 | Midwest Ambulatory Care LLC | Clinic/Center | 1212 N La Salle Dr Ste 100, Chicago, IL 60610-2379 | 2017-08-29 |
| 1447784921 | 1915-25 95th St., LLC | Clinic/Center | 1915 E 95th St, Chicago, IL 60617 | 2017-04-12 |
| 1033652557 | Windy City Surgical Services, LLC | Clinic/Center | 4740 N Cumberland Ave, Chicago, IL 60656-4239 | 2016-12-01 |
| 1548697147 | International Medical and Surgical Institute,sc | Clinic/Center | 2359 N Calfornia Ave, Chicago, IL 60647-2939 | 2013-09-27 |
| 1073813721 | Chicago Foot and Ankle Surgicare, PC | Clinic/Center | 3153 W 111th St, Chicago, IL 60655-2205 | 2010-10-28 |
| 1801106851 | Midwest Medix Surgery Center | Clinic/Center | 8630 S Pulaski Rd, Chicago, IL 60652-3633 | 2010-10-08 |
| 1245466192 | Anti Aging Surgical Center | Clinic/Center | 3918 W 63rd St, Chicago, IL 60629-4604 | 2009-06-05 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.