Healthcare Provider Details

I. General information

NPI: 1194819623
Provider Name (Legal Business Name): CITY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH LAWNDALE NHC 3059 W 26TH STREET
CHICAGO IL
66023
US

IV. Provider business mailing address

CHICAGO DEPARTMENT OF PUBLIC HEALTH 333 S STATE STREET REVENUE #200
CHICAGO IL
60604
US

V. Phone/Fax

Practice location:
  • Phone: 312-747-0066
  • Fax: 612-747-5271
Mailing address:
  • Phone: 312-747-9443
  • Fax: 312-747-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MATTHEW W. BEAUDET
Title or Position: FIRST DEPUTY COMMISSIONER
Credential:
Phone: 312-747-9889