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General NPI Number Information
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NPI Number | 1770739591
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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 | 08/12/2008
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 3120 S KOSTNER AVE
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City | CHICAGO
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State | IL
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Zip | 60623-4842
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Country | US
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Telephone | 773-535-4291
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Fax | 312-829-6842
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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 | 773-829-6673
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State | IL
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