Healthcare Provider Details

I. General information

NPI: 1447381074
Provider Name (Legal Business Name): GREATER FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 DUNDEE AVE
ELGIN IL
60120-4205
US

IV. Provider business mailing address

450 DUNDEE AVE
ELGIN IL
60120-4205
US

V. Phone/Fax

Practice location:
  • Phone: 844-599-3700
  • Fax: 847-608-6775
Mailing address:
  • Phone: 844-599-3700
  • Fax: 847-608-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JASON CAREY
Title or Position: CFO
Credential:
Phone: 847-608-1344