Healthcare Provider Details

I. General information

NPI: 1073617387
Provider Name (Legal Business Name): ALIVIO MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 W. 21ST STREET
CHICAGO IL
60608-4511
US

IV. Provider business mailing address

966 W. 21ST STREET
CHICAGO IL
60608-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax: 312-829-6842
Mailing address:
  • Phone: 773-254-1400
  • Fax: 312-829-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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