Organization
HUMBOLDT PARK HEALTH
Active
Other names
PROHEALTH MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY CHERYL ERINS (CREDENTIALING SPECIALIST)
(269) 244-5256
Entity
Organization
Contact information
Practice address
1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
(773) 292-8200
(773) 278-3899
Mailing address
1799 MOMENTUM PL, LOCK BOX 231799, CHICAGO, IL 60689-5317
(773) 292-8200
(773) 278-3899
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
000007296
IL
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619059
BCBS
—
01
—
945300
GROUP NUMBER
IL
Enumeration date
02/21/2008
Last updated
01/27/2021
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