Organization
ST. CHARLES FAMILY MEDICAL CENTER, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM SCURLOCK (PRESIDENT)
(630) 377-2800
Entity
Organization
Contact information
Practice address
110 S 17TH ST, ST CHARLES, IL 60174-2526
(630) 377-2800
(630) 377-6774
Mailing address
110 S 17TH ST, ST CHARLES, IL 60174-2526
(630) 377-2800
(630) 377-6774
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03060113
STATE LICENSE
IL
01
—
667490
MEDICARE GROUP
IL
Enumeration date
01/04/2007
Last updated
10/19/2007
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