Centro Medico la Villita S.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CENTRO MEDICO LA VILLITA S.C.

Practice address

3356 W 26TH St
Chicago, IL 60623-4037

Phone

(773) 522-7240

Fax

(773) 522-1343

NPI assigned

Jun 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carmen Matchain, M.A.

Title

Medical Assistant

Phone

(773) 522-7240

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457554404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3356 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234037",
            "telephone_number": "773-522-7240",
            "fax_number": "773-522-1343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3356 W 26TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606234037",
            "telephone_number": "773-522-7240",
            "fax_number": "773-522-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO MEDICO LA VILLITA S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MATCHAIN",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_title_or_position": "MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "773-522-7240",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Chicago, IL
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• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.