| Otero Medical Center, S.c. | |
|
4911 W Fullerton Ave Chicago IL 60639-2505 | |
| (773) 772-4900 | |
| (773) 772-0298 |
| Full Name | Otero Medical Center, S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4911 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | William E Otero (PRESIDENT) |
| Authorized Official Contact | 7737724900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Otero Medical Center, S.c. 4911 W Fullerton Ave Chicago IL 60639-2505 Ph: (773) 772-4900 | Otero Medical Center, S.c. 4911 W Fullerton Ave Chicago IL 60639-2505 Ph: (773) 772-4900 |
| NPI Number | 1639306640 |
|---|---|
| Provider Enumeration Date | 06/17/2009 |
| Last Update Date | 08/08/2013 |
| Medicare PECOS PAC ID | 2567515992 |
|---|---|
| Medicare Enrollment ID | O20090803000700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639306640 | NPI | - | NPPES |
| 1588776884 | Other | IL | NPI INDIVIDUAL NUMBER |
| 01626950 | Other | IL | BLUE CROSS BLUE SHIELD OF ILLINOIS |
| 036102552 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036102552 (Illinois) | Primary |
| Provider Name | William E Otero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588776884 PECOS PAC ID: 2668525098 Enrollment ID: I20090803000690 |
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