Organization
PCC COMMUNITY WELLNESS CENTER
Active
Organization
PCC COMMUNITY WELLNESS CENTER
Active
Parent organization
PCC COMMUNITY WELLNESS CENTER
Other names
PCC Dr. Tong Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PCC COMMUNITY WELLNESS CENTER
Authorized official
ROBERT J URSO (PRESIDENT & CEO)
(708) 383-9786
Entity
Organization
Contact information
Practice address
1 ERIE COURT, STE 6040, OAK PARK, IL 60302-2510
(708) 386-1301
(708) 386-3053
Mailing address
1 ERIE COURT, STE 6040, OAK PARK, IL 60302-2510
(708) 386-1301
(708) 386-3053
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141034
MEDICARE PART A PROVIDER NUMBER
—
Enumeration date
07/15/2006
Last updated
07/21/2022
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