Business Information
Business Information
| Business Name |
Family Medicine Specialists S.C.
|
| Street Address (Including Unit or Suite, if applicable) |
---
|
| City, State, Zip |
Richmond, IL 60071
|
| Business Phone |
+18475262151
|
| Business Fax |
---
|
| Email Address |
---
|
| Would you like to sign up for the Village E-Blast for current events and information? |
---
|
| Website Address |
---
|
Business Owner Information
| Business Owner(s) Name |
---
|
| Business Owner(s) Home Address |
---
|
| Business Owner(s) Phone Number (Home or Cellphone) |
---
|
Is This A New Business?
| Is This A New Business? |
No, my business was registered under the same name prior to May 1st of this year.
|
Other Important Information
| Illinois Sales and Use Tax and/or Retailers Occupation Tax |
---
|
| Operating Days |
Monday, Tuesday, Wednesday, Thursday, Friday
|
| Operating Hours |
9am-5pm
|
| Number of Shifts |
1
|
| Number of Employees |
3
|
| Nature of Business |
Medical office
|
Fueling Stations
| Does your business have fueling stations on site? |
No
|
Hoses
Police Required Information
| Burglar Alarm |
No
|
| Fire Alarm |
No
|
| Hazardous Materials |
No
|
Emergency Contacts: Please provide 3 names/phone numbers of key holders who are available 24 hours in case of an emergency.
| 1) Name |
Jason Bellucci
|
| 1) Phone Number |
+18474218204
|
| 2) Name |
Maira Bellucci
|
| 2) Phone Number |
+12246881893
|
Assign Certificate Number
Certification Number
| Certificate No |
---
|
| Fiscal Year |
2026
|
