Organization
ERIE FAMILY HEALTH CENTER INC.
Active
Other names
Erie Amundsen School Base Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GABRIELA NORENA (PATIENT ACCOUNT SUPERVISOR)
(312) 432-7444
Entity
Organization
Contact information
Practice address
5110 N DAMEN AVE, CHICAGO, IL 60625-1317
(312) 666-3494
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
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 SHIELD
IL
01
—
748480
MEDICARE
IL
Enumeration date
04/26/2011
Last updated
04/26/2011
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