| Tpan | |
|
5537 N Broadway St Chicago IL 60640-1405 | |
| (773) 989-9400 | |
| (773) 989-9494 |
| Full Name | Tpan |
|---|---|
| Speciality | Clinic/Center |
| Location | 5537 N Broadway St, Chicago, Illinois |
| Authorized Official Name and Position | Tanya Mauldin (PROVIDER ENROLLMENT MANAGER) |
| Authorized Official Contact | 4142251611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tpan 5537 N Broadway St Chicago IL 60640-1405 Ph: (773) 989-9400 | Tpan 5537 N Broadway St Chicago IL 60640-1405 Ph: (773) 989-9400 |
| NPI Number | 1174896914 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 07/19/2023 |
| Certification Date | 07/19/2023 |
| Medicare PECOS PAC ID | 9133565997 |
|---|---|
| Medicare Enrollment ID | O20240314003547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174896914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dayna L Flores |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1538434212 PECOS PAC ID: 9739535030 Enrollment ID: I20231023002324 |
| Provider Name | Jo-ann Jose |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568722650 PECOS PAC ID: 8729365184 Enrollment ID: I20231226001372 |
| Provider Name | Christina Joly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568007433 PECOS PAC ID: 4688020977 Enrollment ID: I20240314003694 |
| Provider Name | Erin M. Conley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811623580 PECOS PAC ID: 7719327295 Enrollment ID: I20240501000967 |
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 |