# NAVAL HEALTH CLINIC GREAT LAKES ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093044281
- **Authorized official:** MISS JOHNNA ANN MORTON (INDEPENDENT HOSPITAL CORPSMAN)
- **Authorized official phone:** (847) 688-5568

## Contact information

- **Practice address:** 3350 ILLINOIS ST, BLDG 1523, GREAT LAKES, IL 60088-5230
- **Practice address phone:** (847) 688-5568
- **Practice address fax:** (847) 688-4430
- **Mailing address:** 3350 ILLINOIS STREET, BLDG 1523, GREAT LAKES, IL 60088-5230
- **Mailing address phone:** (847) 688-5568
- **Mailing address fax:** (847) 688-4430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1102X | Military Outpatient Operational (Transportable) Component Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/17/2009
- **Last updated:** 12/17/2009