Organization
HARRISON SQUARE
Active
Parent organization
COOK COUNTY
Other names
Harrison Square
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOK COUNTY
Authorized official
SCOTT ANDRLE (DIRECTOR OF MANAGED CARE OPERATIONS)
(312) 864-4649
Entity
Organization
Contact information
Practice address
605 S WOLCOTT AVE, SUITE 605, CHICAGO, IL 60612
(312) 864-4649
(312) 864-9763
Mailing address
15900 SOUTH CICERO AVE., OAK FOREST, IL 60452-4006
(708) 633-3486
(708) 633-3449
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0048
SNF BCBS
IL
05
—
=========
—
IL
Enumeration date
12/28/2006
Last updated
12/23/2024
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