1992797138 NPI number — CITY OF CHICAGO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992797138 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:
1992797138
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:
ROSELAND NEIGHBORHOOD HEALTH CENTER
Provider Second Line Business Practice Location Address:
200 E 115TH STREET
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-747-9500
Provider Business Practice Location Address Fax Number:
312-747-2841
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)