MEDICARE: FRIEND FAMILY HEALTH CENTER- BEETHOVEN

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	:	1578755179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIEND FAMILY HEALTH CENTER- BEETHOVEN

Provider Business Mailing Address
First Line	:	800 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4906
Country	:	US
Telephone Number	:	773-702-0660
Fax Number	:	773-702-4356

Provider Business Practice Location Address
First Line	:	25 W 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4627
Country	:	US
Telephone Number	:	773-702-0660
Fax Number	:	773-702-4356

Authorized Official
Title or Position	:	CFO
Name	:	SABRINA MOORE
Credential	:
Telephone Number	:	773-702-5821

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	04/20/2008

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