MEDICARE: KEELER MEDICAL CENTER SC

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		IL

General Provider Information

NPI Number	:	1265485304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEELER MEDICAL CENTER SC

Provider Business Mailing Address
First Line	:	4215 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2219
Country	:	US
Telephone Number	:	773-826-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60624-2219
Country	:	US
Telephone Number	:	773-826-7474
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY A WILLIAMS
Credential	:	MD
Telephone Number	:	773-826-7474

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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