MEDICARE: ALIVIO MEDICAL CENTER, INC

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)
2	261QS1000X	Student Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001618612	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1427369693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIVIO MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	966 W 21ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4511
Country	:	US
Telephone Number	:	773-214-1400
Fax Number	:	312-829-6375

Provider Business Practice Location Address
First Line	:	3120 S KOSTNER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4842
Country	:	US
Telephone Number	:	312-829-6327
Fax Number	:	312-829-6375

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ESTHER CORPUZ
Credential	:
Telephone Number	:	312-829-6304

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	02/26/2019

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Directions to “ALIVIO MEDICAL CENTER, INC ” Practice Location

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