Provider Demographics
NPI:1659564292
Name:FRANKFORT MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:FRANKFORT MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIAYONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-756-3988
Mailing Address - Street 1:1480 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5314
Mailing Address - Country:US
Mailing Address - Phone:815-464-7212
Mailing Address - Fax:815-464-7251
Practice Address - Street 1:10181 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1274
Practice Address - Country:US
Practice Address - Phone:815-464-7212
Practice Address - Fax:815-464-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36099650207R00000X
IL036099650261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633069OtherBLUE CROSS BLUE SHIELD
IL036099650Medicaid
ILDN0710Medicare PIN
IL210726Medicare Oscar/Certification
IL1633069OtherBLUE CROSS BLUE SHIELD