| Erie Amundsen School Base Health Center | |
|
5110 N Damen Ave Chicago IL 60625-1317 | |
| (312) 666-3494 | |
| Not Available |
| Full Name | Erie Amundsen School Base Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5110 N Damen Ave, Chicago, Illinois |
| Authorized Official Name and Position | Gabriela Norena (PATIENT ACCOUNT SUPERVISOR) |
| Authorized Official Contact | 3124327444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Erie Amundsen School Base Health Center 1701 W Superior St Chicago IL 60622-5646 Ph: (312) 666-3494 | Erie Amundsen School Base Health Center 5110 N Damen Ave Chicago IL 60625-1317 Ph: (312) 666-3494 |
| NPI Number | 1164713129 |
|---|---|
| Provider Enumeration Date | 04/26/2011 |
| Last Update Date | 04/26/2011 |
| Medicare PECOS PAC ID | 9537050422 |
|---|---|
| Medicare Enrollment ID | O20110829000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164713129 | NPI | - | NPPES |
| 1616827 | Other | IL | BLUE CROSS BLUE SHIELD |
| 748480 | Other | IL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 261QF0400X (Illinois) | Primary |
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