| Advocate Illinois Masonic Medical Center | |
|
913 W Wellington Ave Fl 2 Chicago IL 60657-6709 | |
| (873) 843-0200 | |
| Not Available |
| Full Name | Advocate Illinois Masonic Medical Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 913 W Wellington Ave Fl 2, Chicago, Illinois |
| Authorized Official Name and Position | Paul Anderson (SENIOR BUSINESS ANALYST) |
| Authorized Official Contact | 7732966316 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advocate Illinois Masonic Medical Center 21312 Network Pl Chicago IL 60673-1223 Ph: () - | Advocate Illinois Masonic Medical Center 913 W Wellington Ave Fl 2 Chicago IL 60657-6709 Ph: (873) 843-0200 |
| NPI Number | 1861774408 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 02/21/2023 |
| Certification Date | 02/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861774408 | NPI | - | NPPES |
| 04004 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 04004 (Illinois) | Primary |
Philip K Mccullough Md Sc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Huron St, Suite 11-100, Chicago, IL 60611 Phone: 312-695-3680 Fax: 312-926-3709 | |
Amy Lynn, Lcpc, Atr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3020 N Lincoln Ave, Flourish Studios, Chicago, IL 60657 Phone: 773-746-7429 | |
K.a.m Alliance, Inc. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2215 W 95th St Ste 100, Chicago, IL 60643 Phone: 773-239-9600 Fax: 773-239-9601 | |
King Community Mental Health Center Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4455 S King Drive, Suite 101, Chicago, IL 60653 Phone: 773-536-2700 Fax: 773-751-2250 | |
Young Adult Program Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4219 N Lincoln Ave, Chicago, IL 60618 Phone: 773-572-5500 Fax: 773-537-3488 | |
Professional Diagnostic Service, S.c. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 821 W Van Buren St, Chicago, IL 60607 Phone: 312-491-0404 Fax: 312-491-0505 | |
Universal Medical Group Ltd. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 809 E 42nd Pl, Chicago, IL 60653 Phone: 773-285-3422 |