MEDICARE: COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS

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	:	1194991455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH PARTNERSHIP OF ILLINOIS

Provider Business Mailing Address
First Line	:	205 W RANDOLPH ST
Second Line	:	SUITE 2222
City	:	CHICAGO
State	:	IL
Zip	:	60606-1867
Country	:	US
Telephone Number	:	312-795-0000
Fax Number	:	312-795-0002

Provider Business Practice Location Address
First Line	:	13711 W JACKSON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3141
Country	:	US
Telephone Number	:	815-337-9640
Fax Number	:	815-337-9641

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SUSAN BAUER
Credential	:	MA, MPH
Telephone Number	:	312-795-0000

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	04/18/2013

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