1194717330 NPI number — CITY OF CHICAGO

Table of content: (NPI 1194717330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194717330 NPI number — CITY OF CHICAGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CHICAGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHICAGO DEPARTMENT OF PUBLIC HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194717330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CHICAGO DEPARTMENT OF PUBLIC HEALTH
Provider Second Line Business Mailing Address:
333 S STATE STREET REVENUE #200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-747-9443
Provider Business Mailing Address Fax Number:
312-747-9447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOUTH CHICAGO
Provider Second Line Business Practice Location Address:
2938 E 89TH STREET
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-747-5285
Provider Business Practice Location Address Fax Number:
612-787-6161
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEAUDET
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
FIRST DEPUTY COMMISSIONER
Authorized Official Telephone Number:
312-747-9889

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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