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NPI Code Detail

MEDICARE: NEAR NORTH HEALTH SERVICE CORPORATION

MEDICARE: NEAR NORTH HEALTH SERVICE CORPORATION
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1346221553
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEAR NORTH HEALTH SERVICE CORPORATION
Provider Business Mailing Address
First Line : 1276 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60610-2089
Country : US
Telephone Number : 773-268-7600
Fax Number : 773-268-9088
Provider Business Practice Location Address
First Line : 4259 S BERKELEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60653-3030
Country : US
Telephone Number : 773-268-7600
Fax Number : 773-268-9088
Authorized Official
Title or Position : EXECUTIVE
Name : MRS. BERNEICE MILLS-THOMAS
Credential :
Telephone Number : 312-337-1073
Provider Enumeration Date : 11/07/2005
Last Update Date : 07/21/2021

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Directions to “NEAR NORTH HEALTH SERVICE CORPORATION ” Practice Location

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