Organization
ERIE FAMILY HEALTH CENTER, INC
Active
Other names
Erie Westside Family Health
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GABRIELA NORENA (BILLING DEPARTMENT SUPERVISOR)
(312) 432-7444
Entity
Organization
Contact information
Practice address
646 N LAWNDALE AVE, CHICAGO, IL 60624-1254
(312) 432-7423
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
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
Enumeration date
09/28/2007
Last updated
12/15/2008
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