Organization
ERIE FAMILY HEALTH CENTER, INC
Active
Other names
Jose De Diego School Based Hlth
Organization subpart
No
Provider details
NPI number
Authorized official
MISS GABRIELA NORENA (BILLING DEPARTMENT SUPERVISOR)
(312) 432-7444
Entity
Organization
Contact information
Practice address
1313 N CLAREMONT AVE, CHICAGO, IL 60622-2910
(773) 534-4044
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
—
IL
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
06/02/2008
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