MEDICARE: HOWARD BROWN HEALTH CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174H00000X	Health Educator
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1710437991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD BROWN HEALTH CENTER

Provider Business Mailing Address
First Line	:	4025 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2010
Country	:	US
Telephone Number	:	773-388-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5512
Country	:	US
Telephone Number	:	773-388-1600
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MGR
Name	:	BURGUNDY JOHNSON
Credential	:
Telephone Number	:	773-388-1600

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	01/27/2026

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