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General NPI Number Information
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NPI Number | 1336268143
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Entity Type | Organization
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Legal Business Name | COOK COUNTY
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 1240 S DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1122
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Country | US
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Telephone | 312-492-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 W POLK ST RM 220C
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 312-864-4649
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SCOTT ANDRLE
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Credential |
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Telephone | 312-864-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 0005272
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License Number State | IL
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