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BROADWAY MEDICAL CLINIC SC NPI 1609207661


NPI Information

NPI: 1609207661
Provider Name: BROADWAY MEDICAL CLINIC, SC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 14D0416290

Address:
947 S MANNHEIM RD
WESTCHESTER, IL
ZIP 60154
Phone: (708) 343-1300
Get Directions

BROADWAY MEDICAL CLINIC, SC is a pediatrics in Westchester, IL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. BROADWAY MEDICAL CLINIC, SC NPI is 1609207661. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

947 S MANNHEIM RD
WESTCHESTER, IL
ZIP 60154-515
Phone: (708) 343-1300

The provider's authorized official is Afsoon Karimi .
The authorized official title is Owner and has the following contact phone number (708) 343-1300.

The CLIA number assigned to this NPI record is 14D0416290 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/2/2013 and was last updated on 12/2/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1036110016MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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