Provider Demographics
NPI:1952524027
Name:ASSOCIATED MEDICAL CENTERS SC
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL CENTERS SC
Other - Org Name:HYDE PARK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-7746
Mailing Address - Street 1:5307 SO HYDE PARK BLVD
Mailing Address - Street 2:ST 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:773-288-8808
Mailing Address - Fax:773-288-8792
Practice Address - Street 1:5307 SO HYDE PARK BLVD
Practice Address - Street 2:ST 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-288-8808
Practice Address - Fax:773-288-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630238OtherBCBS