Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
National Teachers Academy Clinic IHH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY TAYLOR (CEO)
(312) 413-1261
Entity
Organization
Contact information
Practice address
55 W CERMAK RD, CHICAGO, IL 60616-2001
(312) 996-2000
Mailing address
1220 S WOOD ST, CHICAGO, IL 60608-1202
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BLUE CROSS
IL
Enumeration date
10/25/2018
Last updated
10/25/2018
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