Active NPI
Viru SC
- Family Medicine Physician
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036-115930
- Legal business name
- VIRU SC
- Practice address
- 2412 W Fullerton Ave
Chicago, IL 60647-3155 - Phone
- (773) 423-6178
- Fax
- (773) 451-8285
- NPI assigned
- Sep 18, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jacqueline Olivo, M.D.
- Title
- President
- Phone
- (773) 716-7281
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-115930 | IL | Primary |
Addresses
Primary practice location
2412 W Fullerton Ave
Chicago, IL 60647-3155
Mailing address
2412 W Fullerton Ave
Chicago, IL 60647-3155
Phone (773) 423-6178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Olivo Medical Wellness Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
2143 W Wellington Ave
Ste 100
Chicago, IL 60618
Phone (773) 528-5400
Practitioners & affiliated clinicians
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.
-
- Family Medicine Physician
- Chicago, IL
- NPI 1295767366
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190073600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626134400000",
"number": "1922294503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2412 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606473155",
"telephone_number": "773-423-6178",
"fax_number": "773-451-8285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2412 W FULLERTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606473155",
"telephone_number": "773-423-6178",
"fax_number": "773-451-8285"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VIRU SC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-18",
"last_updated": "2021-07-13",
"certification_date": "2021-07-13",
"status": "A",
"authorized_official_last_name": "OLIVO",
"authorized_official_first_name": "JACQUELINE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "773-716-7281",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "IL",
"license": "036-115930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.