Provider Demographics
NPI:1033310933
Name:JOHN C FARMER MD SC
Entity Type:Organization
Organization Name:JOHN C FARMER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-375-1300
Mailing Address - Street 1:8741 S GREENWOOD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7061
Mailing Address - Country:US
Mailing Address - Phone:773-375-1300
Mailing Address - Fax:773-375-1312
Practice Address - Street 1:8741 S GREENWOOD AVE
Practice Address - Street 2:STE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7061
Practice Address - Country:US
Practice Address - Phone:773-375-1300
Practice Address - Fax:773-375-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209844Medicare ID - Type Unspecified