1649324211 NPI number — SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION

Table of content: (NPI 1649324211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649324211 NPI number — SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION
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:
SIDNEY HILLMAN HEALTH CENTRE
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:
1649324211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 S ASHLAND AVE
Provider Second Line Business Mailing Address:
FOURTH AND FIFTH FLOOR
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60607-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-738-6170
Provider Business Mailing Address Fax Number:
312-942-1554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S ASHLAND AVE
Provider Second Line Business Practice Location Address:
FOURTH AND FIFTH FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60607-2703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-738-6170
Provider Business Practice Location Address Fax Number:
312-942-1554
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEDINA
Authorized Official First Name:
ADRIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
312-738-6196

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1649324211 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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