Healthcare Provider Details

I. General information

NPI: 1710096482
Provider Name (Legal Business Name): ALIVIO MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 S. WESTERN AVE.
CHICAGO IL
60608-3837
US

IV. Provider business mailing address

966 W 21ST ST
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax: 312-829-6673
Mailing address:
  • Phone: 773-254-1400
  • Fax: 312-829-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number1138738
License Number StateIL

VIII. Authorized Official

Name: MRS. ESTHER CORPUZ
Title or Position: CEO
Credential:
Phone: 312-829-6304