DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

MEDICARE: THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11622185OTHERILBCBS

General Provider Information

NPI Number : 1841614609
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Provider Business Mailing Address
First Line : 845 S DAMEN AVE
Second Line : M/C 802
City : CHICAGO
State : IL
Zip : 60612-3727
Country : US
Telephone Number : 312-996-7663
Fax Number : 312-996-3512
Provider Business Practice Location Address
First Line : 3240 W DIVISION ST
Second Line :
City : CHICAGO
State : IL
Zip : 60651-2405
Country : US
Telephone Number : 312-413-7425
Fax Number : 312-996-3512
Authorized Official
Title or Position : DIRECTOR
Name : ELIZABETH M RALEIGH
Credential :
Telephone Number : 312-996-7663
Provider Enumeration Date : 02/13/2014
Last Update Date : 01/22/2016

Similar Medicare Providers

1134507247 — CELINA CANTU LCSW
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax:
1619400074 — KEISHA NICOLE HOUSE
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax: 312-413-2588
1972079358 — BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax:
1255803045 — BERNARD J VONDERHAAR DNP
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax:
1316595747 — MR. MICHAEL ANTHONY HUYCK RN
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax:
1114516812 — KELLY THERESE MOORE RN, DNP STUDENT
Practice Location Address:
3240 W DIVISION ST
CHICAGO, IL
60651-2405
Practice Phone: 312-413-7425
Practice Fax:

Directions to “THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.