MEDICARE: CIRCLE FAMILY HEALTHCARE NETWORK, 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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1649399106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCLE FAMILY HEALTHCARE NETWORK, INC

Provider Business Mailing Address
First Line	:	5002 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4127
Country	:	US
Telephone Number	:	773-379-1000
Fax Number	:	773-379-1342

Provider Business Practice Location Address
First Line	:	115 PARKSIDE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3040
Country	:	US
Telephone Number	:	773-921-9669
Fax Number	:	773-921-2609

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANDRE' HINES
Credential	:
Telephone Number	:	773-379-1000

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/07/2010

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