1922324235 NPI number — CHICAGO DEPARTMENT OF PUBLIC HEALTH

Table of content: (NPI 1922324235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922324235 NPI number — CHICAGO DEPARTMENT OF PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO DEPARTMENT OF PUBLIC HEALTH
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:
CDPH
Provider Other Organization Name Type Code:
5
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:
1922324235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 S STATE ST
Provider Second Line Business Mailing Address:
ROOM 200 - REVENUE
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60604-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-747-9545
Provider Business Mailing Address Fax Number:
312-745-7603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S STATE ST
Provider Second Line Business Practice Location Address:
ROOM 200 - REVENUE
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60604-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-747-9545
Provider Business Practice Location Address Fax Number:
312-745-7603
Provider Enumeration Date:
04/12/2010

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)

  • Identifier: 14D0664531 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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