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
1	261QC1500X	Community Health Clinic/Center		IL

General Provider Information

NPI Number	:	1194819623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CHICAGO

Provider Business Mailing Address
First Line	:	CHICAGO DEPARTMENT OF PUBLIC HEALTH
Second Line	:	333 S STATE STREET REVENUE #200
City	:	CHICAGO
State	:	IL
Zip	:	60604
Country	:	US
Telephone Number	:	312-747-9443
Fax Number	:	312-747-9447

Provider Business Practice Location Address
First Line	:	SOUTH LAWNDALE NHC
Second Line	:	3059 W 26TH STREET
City	:	CHICAGO
State	:	IL
Zip	:	66023
Country	:	US
Telephone Number	:	312-747-0066
Fax Number	:	612-747-5271

Authorized Official
Title or Position	:	FIRST DEPUTY COMMISSIONER
Name	:	MATTHEW W. BEAUDET
Credential	:
Telephone Number	:	312-747-9889

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/28/2010

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Directions to “CITY OF CHICAGO ” Practice Location

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