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FAMILY DOCTOR MEDICAL CENTER
NPI 1336516780
Clinic/Center - Medical Specialty in Chicago, IL

Active since September 01, 2015CLIA 14D0989402 · Waiver
1918 W IRVING PARK RD, CHICAGO, IL 60613(773) 940-1612 Get Directions Write a Review

NPPES record last updated: September 1, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Family Doctor Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAMILY DOCTOR MEDICAL CENTER (NPI 1336516780) is a healthcare organization registered as a medical specialty in Chicago, Illinois and active in the NPI registry since September 2015. The organization holds a CLIA Waiver certificate valid through July 24, 2027 and lists Julia Jackson, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1336516780
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameFAMILY DOCTOR MEDICAL CENTER
Location Address1918 W IRVING PARK RDChicago, IL 60613-2408
Mailing Address1918 W Irving Park RdChicago, IL 60613-2408 · (773) 940-1612
Phone(773) 940-1612
Organization SubpartYesParent: Family Doc, Inc.
Authorized OfficialJulia JacksonOffice Manager · (773) 940-1612
Enumeration DateSeptember 1, 2015
✔ NPI 1336516780 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in IL · 036101658
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
1918 W IRVING PARK RD, Chicago, IL 60613
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Other Identifiers 3

Medicare PINH16264IL
Medicaid20000890IL
Medicare UPIN702060IL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0989402

Family Doctor Medical Center · Chicago, IL
Active · expires Jul 24, 2027
CLIA Number14D0989402
Laboratory TypePhysician Office
Certificate Effective DateJuly 25, 2025
Certificate Expiration DateJuly 24, 2027
Laboratory DirectorAdebayo A. Bademosi
Laboratory Phone(773) 940-1612
Laboratory LocationFamily Doctor Medical Center7201-07 S Stony Island Ave, Chicago, IL 60649
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DARLENE EGUES MD
Pediatrics
1918 W IRVING PARK RD
CHICAGO, IL 60613
Cook County (773) 477-4900
CHICAGO PEDIATRIC CLINIC
Pediatrics
1918 W IRVING PARK RD
CHICAGO, IL 60613
Cook County (773) 477-4900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Family Doctor Medical Center's NPI number?

The NPI number for Family Doctor Medical Center is 1336516780. It was assigned to this organization in the NPPES registry on September 1, 2015.

Where is Family Doctor Medical Center located?

Family Doctor Medical Center is located at 1918 W Irving Park Rd, Chicago, IL 60613. The listed phone number is (773) 940-1612.

What is Family Doctor Medical Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Does Family Doctor Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0989402) is associated with this NPI, valid through July 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Family Doctor Medical Center was last updated on September 1, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.