Healthcare Provider Details

I. General information

NPI: 1649324211
Provider Name (Legal Business Name): SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/05/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S ASHLAND AVE FOURTH AND FIFTH FLOOR
CHICAGO IL
60607-2703
US

IV. Provider business mailing address

333 S ASHLAND AVE FOURTH AND FIFTH FLOOR
CHICAGO IL
60607-2703
US

V. Phone/Fax

Practice location:
  • Phone: 312-738-6170
  • Fax: 312-942-1554
Mailing address:
  • Phone: 312-738-6170
  • Fax: 312-942-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA MEDINA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 312-738-6196