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	261QS1000X	Student Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141854	OTHER	IL	MEDICARE TPAN
3	141077	OTHER	IL	MEDICARE TPAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0001618612	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1437464039
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	:	773-254-1400
Fax Number	:	312-243-1705

Provider Business Practice Location Address
First Line	:	1940 W. 18TH STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1903
Country	:	US
Telephone Number	:	773-254-1400
Fax Number	:	312-829-6375

Authorized Official
Title or Position	:	CFO
Name	:	ANKIT PATEL
Credential	:
Telephone Number	:	312-312-2719

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	04/22/2026

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Directions to “ALIVIO MEDICAL CENTER INC ” Practice Location

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