| Pcc Austin Family Health Center | |
|
5425 W Lake St Chicago IL 60644-2342 | |
| (773) 378-3347 | |
| (773) 378-4028 |
| Full Name | Pcc Austin Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5425 W Lake St, Chicago, Illinois |
| Authorized Official Name and Position | Alyssa Sianghio (PRESIDENT CEO) |
| Authorized Official Contact | 7085247686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pcc Austin Family Health Center 5461 W Lake St Chicago IL 60644 Ph: (773) 378-3347 | Pcc Austin Family Health Center 5425 W Lake St Chicago IL 60644-2342 Ph: (773) 378-3347 |
| NPI Number | 1609892223 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 10/16/2024 |
| Medicare PECOS PAC ID | 1557270139 |
|---|---|
| Medicare Enrollment ID | O20081121000628 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609892223 | NPI | - | NPPES |
| 141889 | Other | MEDICARE PART A PROVIDER NUMBER | |
| ========= | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 002 (Illinois) | Primary |
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