Organization
ERIE FAMILY HEALTH CENTER INC
Active
Organization
ERIE FAMILY HEALTH CENTER INC
Active
Other names
Erie Division Street 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
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(312) 666-3494
(312) 666-0610
Mailing address
1701 W SUPERIOR, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-0610
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1616827
BLUE CROSS BLUE SHIELD
IL
01
—
748480
MEDICARE
IL
Enumeration date
05/02/2012
Last updated
05/02/2012
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