# CITY OF CHICAGO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chicago Department of Public Health Revenue 3200
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194725192
- **Authorized official:** TYANNA QUALLS (PROJECTS ADMINISTRATOR)
- **Authorized official phone:** (312) 747-2203

## Contact information

- **Practice address:** 111 W WASHINGTON ST FL 4, CHICAGO, IL 60602-2703
- **Practice address phone:** (312) 747-9884
- **Practice address fax:** (312) 747-9447
- **Mailing address:** 111 W WASHINGTON ST FL 4, CHICAGO, IL 60602-2703
- **Mailing address phone:** (312) 747-9443
- **Mailing address fax:** (312) 747-9447

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | IL | Yes |

## Other

- **Enumeration date:** 08/01/2005
- **Last updated:** 11/14/2024