Provider Demographics
NPI:1851456909
Name:FULLERTON MEDICAL SURGICAL CENTER
Entity Type:Organization
Organization Name:FULLERTON MEDICAL SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-622-8060
Mailing Address - Street 1:5723 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2306
Mailing Address - Country:US
Mailing Address - Phone:773-622-8060
Mailing Address - Fax:773-622-8095
Practice Address - Street 1:5723 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2306
Practice Address - Country:US
Practice Address - Phone:773-622-8060
Practice Address - Fax:773-622-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical