MEDICARE: CHICAGO WOMEN'S HEALTH, ORGANIZATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VC0300X	Complex Family Planning Physician

General Provider Information

NPI Number	:	1265209720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO WOMEN'S HEALTH, ORGANIZATION, LLC

Provider Business Mailing Address
First Line	:	2918 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4702
Country	:	US
Telephone Number	:	601-594-7043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3410
Country	:	US
Telephone Number	:	773-961-7425
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SHANNON L BREWER
Credential	:
Telephone Number	:	601-594-7043

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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