MEDICARE: BRIDGEPORT FAMILY MEDICAL CENTER S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1588983332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEPORT FAMILY MEDICAL CENTER S.C.

Provider Business Mailing Address
First Line	:	3201 S WALLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-6061
Country	:	US
Telephone Number	:	312-326-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 S WALLACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3501
Country	:	US
Telephone Number	:	312-326-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERROLD SCHWARTZ
Credential	:	D.O.
Telephone Number	:	312-203-2714

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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