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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