Organization
ERIE FAMILY HEALTH CENTER INC.
Active
Other names
Erie Clemente Wildcats Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GABRIELA NORENA (BILLING DEPARTMENT SUPREVISOR)
(312) 432-7444
Entity
Organization
Contact information
Practice address
1147 N WESTERN AVE, CHICAGO, IL 60622-2931
(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
261QF0400X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
BLUE CROSS BLUE SHILED PROVIDER NUMBER
IL
01
—
748480
MEDICARE PART B
IL
Enumeration date
03/18/2009
Last updated
03/18/2009
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