MEDICARE: MERCY PHILLIPS HEALTH CENTER

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	291U00000X	Clinical Medical Laboratory	771115016	IL
2	261QS1000X	Student Health Clinic/Center	0001578	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	771115016	OTHER	IL	DHS
2	14D1036279	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1730310251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY PHILLIPS HEALTH CENTER

Provider Business Mailing Address
First Line	:	244 E PERSHING RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2222
Country	:	US
Telephone Number	:	312-567-7058
Fax Number	:	312-328-7982

Provider Business Practice Location Address
First Line	:	244 E PERSHING RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-2222
Country	:	US
Telephone Number	:	312-567-7058
Fax Number	:	312-328-7982

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	MRS. PATRICE KATHLEEN GRIFFIN
Credential	:
Telephone Number	:	312-567-5593

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/13/2017

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Directions to “MERCY PHILLIPS HEALTH CENTER ” Practice Location

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