Mary L. Kelly, D.O., S.C.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

036077560 Issued in IL

Legal business name

MARY L. KELLY, D.O., S.C.

Practice address

7319 North Ave
River Forest, IL 60305-1220

Phone

(708) 848-0040

Fax

(708) 848-2931

NPI assigned

Sep 4, 2008

Last updated

Sep 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary L. L Kelly, D.O.

Title

President

Phone

(708) 848-0080

Specialties & licenses 1

Addresses

Tax ID family

Dr Mary Kelly2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr Mary Kelly

  • Family Medicine Physician
  • River Forest, IL
  • NPI 1164683157
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary Louise Kelly, D.O.

  • Family Medicine Physician
  • Oak Park, IL
  • NPI 1912087560
  NPD (past)

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220486400000",
    "number": "1497903314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7319 NORTH AVE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051220",
            "telephone_number": "708-848-0040",
            "fax_number": "708-848-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7319 NORTH AVE",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603051220",
            "telephone_number": "708-848-0040",
            "fax_number": "708-848-2931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY L. KELLY, D.O., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-04",
        "last_updated": "2008-09-04",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARY L.",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-848-0080",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "036077560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mantilla Surgical SC
• Mark Tomera MC
• Markovic Medical Inc
• Gary Marshall Mart, M.D.
• Barbara Martin, MA CCC-SLP
• George Robert Mason, M.D.
• Pearly Mathew, SLP
• Meghan Matz, WHNP
• Colleen McAdams, OTR
• Michael P. McCafferty, DDS

• Medical Specialty Clinic/Center in River Forest, IL
• Providers in River Forest, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; 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.