1093715237 NPI number — CHICAGO CITY OF

Table of content: (NPI 1093715237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093715237 NPI number — CHICAGO CITY OF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO CITY OF
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:
Provider Other Organization Name Type Code:
6
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:
1093715237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2022
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:
REVENUE #200
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:
312-747-9443
Provider Business Mailing Address Fax Number:
312-747-9447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S STATE ST
Provider Second Line Business Practice Location Address:
REVENUE #200
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:
312-747-9443
Provider Business Practice Location Address Fax Number:
312-747-9447
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROJECTS ADMINISTRATOR
Authorized Official Telephone Number:
312-747-9545

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , 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: EIN , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com