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NPI Code Detail

MEDICARE: CITY OF CHICAGO

MEDICARE: CITY OF CHICAGO
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
1261QC1500XCommunity Health Clinic/CenterIL

General Provider Information

NPI Number : 1194725192
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OF CHICAGO
Provider Business Mailing Address
First Line : 111 W WASHINGTON ST FL 4
Second Line :
City : CHICAGO
State : IL
Zip : 60602-2703
Country : US
Telephone Number : 312-747-9443
Fax Number : 312-747-9447
Provider Business Practice Location Address
First Line : 111 W WASHINGTON ST FL 4
Second Line :
City : CHICAGO
State : IL
Zip : 60602-2703
Country : US
Telephone Number : 312-747-9884
Fax Number : 312-747-9447
Authorized Official
Title or Position : PROJECTS ADMINISTRATOR
Name : TYANNA QUALLS
Credential :
Telephone Number : 312-747-2203
Provider Enumeration Date : 08/01/2005
Last Update Date : 11/14/2024

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Directions to “CITY OF CHICAGO ” Practice Location

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