MEDICARE: CHICAGO FAMILY HEALTH CENTER - L

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	:	1497097596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO FAMILY HEALTH CENTER - L

Provider Business Mailing Address
First Line	:	9119 S EXCHANGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3223 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-3333
Country	:	US
Telephone Number	:	773-768-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WARREN BRODINE
Credential	:
Telephone Number	:	773-768-5000

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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