# FAMILY MEDICAL CENTER OF BOLINGBROOK SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376668475
- **Authorized official:** DR. ANTONIO CARLINO D.O. (OWNER)
- **Authorized official phone:** (630) 739-2878

## Contact information

- **Practice address:** 516 E BOUGHTON RD, BOLINGBROOK, IL 60440-2181
- **Practice address phone:** (630) 739-2878
- **Mailing address:** 516 E BOUGHTON RD, BOLINGBROOK, IL 60440-2181

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036-098970 | IL | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 05/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 556070 | MEDICARE GRP\# | IL |