Provider Demographics
NPI:1184636516
Name:CIRCLE MEDICAL MANAGEMENT, INC.
Entity type:Organization
Organization Name:CIRCLE MEDICAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERSIVOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-829-1424
Mailing Address - Street 1:1426 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1821
Mailing Address - Country:US
Mailing Address - Phone:312-829-1424
Mailing Address - Fax:312-850-8425
Practice Address - Street 1:1426 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1821
Practice Address - Country:US
Practice Address - Phone:312-829-1424
Practice Address - Fax:312-850-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36061118261QE0700X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========OtherUDED FOR COMM INS
IL142540Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER