NPIMap

Organization Active NPI

Jefferson Park Medical Center, LTD.

  • Medical Specialty Clinic/Center
  • Chicago, IL
National Provider Identifier
1952577926
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
042.619228 Issued in IL
Legal business name
JEFFERSON PARK MEDICAL CENTER, LTD.
Practice address
4955 N Milwaukee Ave Ste 4
Chicago, IL 60630-2175
Phone
(773) 736-3770
Fax
(773) 736-1403
NPI assigned
Apr 30, 2008
Last updated
Apr 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

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

Authorized official

Name
Milroy EmmanuelNPI 1578772570
Title
Incorporator
Phone
(773) 736-3770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 042.619228 IL Primary

Addresses

Primary practice location

4955 N Milwaukee Ave Ste 4
Chicago, IL 60630-2175

Mailing address

4955 N Milwaukee Ave Ste 4
Chicago, IL 60630-2175
Phone (773) 736-3770

National Provider Directory

National Provider Directory

Locations

4955 N Milwaukee Ave
Ste 4
Chicago, IL 60630
Phone (773) 736-3770

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.

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1952577926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 N MILWAUKEE AVE STE 4",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302175",
            "telephone_number": "773-736-3770",
            "fax_number": "773-736-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 N MILWAUKEE AVE STE 4",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302175",
            "telephone_number": "773-736-3770",
            "fax_number": "773-736-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PARK MEDICAL CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "EMMANUEL",
        "authorized_official_first_name": "MILROY",
        "authorized_official_title_or_position": "INCORPORATOR",
        "authorized_official_telephone_number": "773-736-3770"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "042.619228",
            "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 Apr 30, 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.