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General NPI Number Information
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NPI Number | 1609264001
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Entity Type | Organization
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Legal Business Name | ALIVIO MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6447 CERMAK RD SUITE 100
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City | BERWYN
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State | IL
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Zip | 60402-2311
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Country | US
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Telephone | 773-254-1400
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Fax | 773-650-1239
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Provider Business Mailing Address
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Address Line | 966 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-4511
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Country | US
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Telephone | 773-254-1400
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Fax | 773-650-1239
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Authorized Official
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Title or Position | CEO
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Name | MRS. ESTHER CORPUZ
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Credential |
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Telephone | 312-829-6304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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