Organization
ERIE FAMILY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE FRANCIS MD, MPH (PESIDENT AND CEO)
(312) 432-7394
Entity
Organization
Contact information
Practice address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 432-7394
Mailing address
1701 W SUPERIOR ST, 3RD FLOOR, CHICAGO, IL 60622-5646
(312) 432-7394
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 PROVIDER NUMBER
IL
01
—
748480
MEDICARE PART B
IL
01
—
F100260003
MEDICARE PART B PTAN
WI
Enumeration date
08/02/2006
Last updated
11/02/2020
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