Provider Demographics
NPI:1285745125
Name:ELGIN FAMILY PHYSICIANS, SC
Entity type:Organization
Organization Name:ELGIN FAMILY PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-888-3661
Mailing Address - Street 1:87 N AIRLITE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4991
Mailing Address - Country:US
Mailing Address - Phone:847-888-3661
Mailing Address - Fax:847-888-9964
Practice Address - Street 1:87 N AIRLITE ST STE 130
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4991
Practice Address - Country:US
Practice Address - Phone:847-888-3661
Practice Address - Fax:847-888-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042006899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
951280OtherMEDICARE GROUP NUMBER