Organization
ERIE FAMILY HEALTH CENTER, INC
Active
Other names
Erie Teen Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GABRIELA NORENA (BILLING DEPARTMENT SUPERVISOR)
(312) 432-7444
Entity
Organization
Contact information
Practice address
1945 W WILSON AVE FL 5, CHICAGO, IL 60640-5255
(312) 666-3494
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
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 PROVIDER NUMBER
IL
Enumeration date
09/28/2007
Last updated
06/02/2008
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