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General NPI Number Information
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NPI Number | 1003158981
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Entity Type | Organization
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Legal Business Name | URBAN FAMILY HEALTH CENTER INC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 10830 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-3126
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Country | US
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Telephone | 773-264-1400
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Fax | 773-264-1401
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Provider Business Mailing Address
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Address Line | 10830 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-3126
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Country | US
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Telephone | 773-264-1400
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Fax | 773-264-1401
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. EDWIN ENEFIOK EKONG
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Credential | D.O.
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Telephone | 773-264-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036062189
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License Number State | IL
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