St. Charles Family Medical Center, SC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ST. CHARLES FAMILY MEDICAL CENTER, SC

Practice address

110 S 17TH St
St Charles, IL 60174-2526

Phone

(630) 377-2800

Fax

(630) 377-6774

NPI assigned

Jan 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. William Scurlock

Title

President

Phone

(630) 377-2800

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1912054891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S 17TH ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742526",
            "telephone_number": "630-377-2800",
            "fax_number": "630-377-6774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S 17TH ST",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742526",
            "telephone_number": "630-377-2800",
            "fax_number": "630-377-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CHARLES FAMILY MEDICAL CENTER, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "SCURLOCK",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-377-2800",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "03060113",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "667490",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Nicole Squiers, OTR/L
• Georgina Srinivas Rao, MD
• St Charles Plastic Surgery, LTD.
• St Charles Skilled Nursing Facility LLC
• St. Charles Family Dentristry L.T.D.
• St. Charles Foot and Ankle Center PC
• St. Charles Memory Care, LLC
• St. Charles Modern Dental, LLC
• St. Charles NH LLC
• St. Charles Pain and Wellness Center, LLC

• Specialist in St Charles, IL
• Providers in St Charles, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; 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.