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Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
UIH-Mile Square Center at South Shore IHH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY TAYLOR (CEO)
(312) 413-1261
Entity
Organization
Contact information
Practice address
7037 S STONY ISLAND AVE, CHICAGO, IL 60649-1905
(312) 413-1261
Mailing address
1220 S WOOD ST, CHICAGO, IL 60608-1202
(312) 413-1261
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS PROVIDER
IL
Enumeration date
10/23/2018
Last updated
10/25/2018
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