Provider Demographics
NPI:1538345756
Name:SHEFFIELD FAMILY MEDICAL CENTER S.C.
Entity type:Organization
Organization Name:SHEFFIELD FAMILY MEDICAL CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:CERNOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-454-2811
Mailing Address - Street 1:113 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61361-9752
Mailing Address - Country:US
Mailing Address - Phone:815-454-2811
Mailing Address - Fax:815-454-2832
Practice Address - Street 1:113 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:IL
Practice Address - Zip Code:61361-9752
Practice Address - Country:US
Practice Address - Phone:815-454-2811
Practice Address - Fax:815-454-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071681Medicaid
ILK51368Medicare PIN
IL036071681Medicaid
IL080184991Medicare PIN
IL201325Medicare PIN