MEDICARE: ADVOCATE NORTHSIDE HEALTH SYSTEM

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	04004	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861774408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATE NORTHSIDE HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	21312 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	913 W WELLINGTON AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6709
Country	:	US
Telephone Number	:	873-843-0200
Fax Number	:

Authorized Official
Title or Position	:	SENIOR BUSINESS ANALYST
Name	:	PAUL ANDERSON
Credential	:
Telephone Number	:	773-296-6316

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	02/21/2023

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