Organization
ERIE FAMILY HEALTH CENTER INC
Active
Organization
ERIE FAMILY HEALTH CENTER INC
Active
Other names
Erie Johnson Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEE FRANCIS (PRESIDENT AND CEO)
(312) 432-7394
Entity
Organization
Contact information
Practice address
1504 S ALBANY, CHICAGO, IL 60623-2209
(312) 666-3494
(312) 666-0610
Mailing address
1701 W SUPERIOR, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
BLUE CROSS BLUE SHIELD PROVIDE NUMBER
IL
01
—
748480
MEDICARE PART B
IL
Enumeration date
09/28/2007
Last updated
11/02/2020
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