Provider Demographics
NPI:1316123961
Name:COMMUNITY FAMILY MEDICINE LTD
Entity type:Organization
Organization Name:COMMUNITY FAMILY MEDICINE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-487-3017
Mailing Address - Street 1:6307 S STEWART AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3116
Mailing Address - Country:US
Mailing Address - Phone:773-487-3017
Mailing Address - Fax:773-487-3028
Practice Address - Street 1:6307 S STEWART AVE STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-487-3017
Practice Address - Fax:773-487-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067419261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1306899216OtherPROVIDER NPI
IL036067419Medicaid
IL705890Medicare PIN
IL1306899216OtherPROVIDER NPI