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	:	1194179721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS COMMUNITY HEALTH NETWORK

Provider Business Mailing Address
First Line	:	600 W FULTON
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60661-1262
Country	:	US
Telephone Number	:	312-526-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1723 HOWARD ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3735
Country	:	US
Telephone Number	:	773-381-8700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DONNA THOMPSON
Credential	:
Telephone Number	:	312-526-2051

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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