Organization
ERIE FAMILY HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA NORENA (BILLING MANAGER)
(312) 432-7444
Entity
Organization
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
B/C B/S
IL
01
—
748480
MEDICARE PART B
IL
Enumeration date
09/17/2012
Last updated
09/17/2012
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