Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other names
SMYTH JOYNER SCHOOL BASED CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
INN LEE (ASSOCIATE DIRECTOR)
(312) 413-9854
Entity
Organization
Contact information
Practice address
1059 W 13TH ST, CHICAGO, IL 60608-1526
(312) 996-2000
(312) 413-1782
Mailing address
2045 W WASHINGTON BLVD, M/C 698, CHICAGO, IL 60612-2428
(312) 996-2000
(312) 413-1782
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1622185
BCBS PROVIDER ID
—
Enumeration date
07/19/2006
Last updated
02/21/2008
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