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NPI Code Detail

MEDICARE: ALIVIO MEDICAL CENTER, INC.

MEDICARE: ALIVIO MEDICAL CENTER, INC.
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
1261Q00000XClinic/CenterIL
2261QF0400XFederally Qualified Health Center (FQHC)1138738IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11618612OTHERILBCBS
2141854OTHERILTPAN NUMBER

General Provider Information

NPI Number : 1710096482
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALIVIO MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : 966 W 21ST ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4511
Country : US
Telephone Number : 773-254-1400
Fax Number : 312-829-6673
Provider Business Practice Location Address
First Line : 2355 S. WESTERN AVE.
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3837
Country : US
Telephone Number : 773-254-1400
Fax Number : 312-829-6673
Authorized Official
Title or Position : CEO
Name : MRS. ESTHER CORPUZ
Credential :
Telephone Number : 312-829-6304
Provider Enumeration Date : 08/29/2006
Last Update Date : 08/31/2023

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