Provider Demographics
NPI:1356592828
Name:FRIENDLY FAMILY MEDICAL CARE, INC.
Entity type:Organization
Organization Name:FRIENDLY FAMILY MEDICAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MORRIS-CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-464-0081
Mailing Address - Street 1:10225 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1279
Mailing Address - Country:US
Mailing Address - Phone:815-464-0081
Mailing Address - Fax:815-464-0538
Practice Address - Street 1:10225 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1279
Practice Address - Country:US
Practice Address - Phone:815-464-0081
Practice Address - Fax:815-464-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101122261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH23330Medicare UPIN