Organization
ALIVIO MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ESTHER CORPUZ (CEO)
(312) 829-6304
Entity
Organization
Contact information
Practice address
ALIVIO MEDICAL CTR, 75 REMITTANCE DR. SUITE 6577, CHICAGO, IL 60675-6577
(312) 829-6327
(312) 829-6843
Mailing address
966 W 21ST ST, CHICAGO, IL 60608-4511
(773) 254-1400
(312) 829-6843
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001618612
BCBS
IL
05
—
036100871 3
—
IL
05
—
036113015 3
—
IL
05
—
036118630 1
—
IL
01
—
141077
TPAN
IL
01
—
920890
MEDICARE PART B TPAN
IL
Enumeration date
08/13/2008
Last updated
08/19/2014
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