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General NPI Number Information
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NPI Number | 1144405721
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Entity Type | Organization
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Legal Business Name | TILMANS COMMUNITY HEALTH CLINIC, INC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7318 S RACINE AVE
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City | CHICAGO
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State | IL
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Zip | 60636-4112
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Country | US
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Telephone | 773-874-8083
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Fax | 773-874-8146
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Provider Business Mailing Address
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Address Line | 7318 S RACINE AVE
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City | CHICAGO
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State | IL
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Zip | 60636-4112
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Country | US
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Telephone | 773-874-8083
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Fax | 773-874-8146
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAURA KELLY
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Credential |
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Telephone | 773-874-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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