MEDICARE: ACCESS COMMUNITY HEALTH NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1043381486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS COMMUNITY HEALTH NETWORK

Provider Business Mailing Address
First Line	:	222 N CANAL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60606-1206
Country	:	US
Telephone Number	:	312-526-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6631 N BOSWORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4223
Country	:	US
Telephone Number	:	773-761-5035
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DONNA THOMPSON
Credential	:
Telephone Number	:	312-526-2200

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	01/28/2011

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