| Erie Clemente Wildcats Health Center | |
|
1147 N Western Ave Chicago IL 60622-2931 | |
| (312) 666-3494 | |
| Not Available |
| Full Name | Erie Clemente Wildcats Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1147 N Western Ave, Chicago, Illinois |
| Authorized Official Name and Position | Gabriela Norena (BILLING DEPARTMENT SUPREVISOR) |
| Authorized Official Contact | 3124327444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Erie Clemente Wildcats Health Center 1701 W Superior St Chicago IL 60622-5646 Ph: (312) 666-3494 | Erie Clemente Wildcats Health Center 1147 N Western Ave Chicago IL 60622-2931 Ph: (312) 666-3494 |
| NPI Number | 1144461385 |
|---|---|
| Provider Enumeration Date | 03/18/2009 |
| Last Update Date | 03/18/2009 |
| Medicare PECOS PAC ID | 9537050422 |
|---|---|
| Medicare Enrollment ID | O20090616000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144461385 | NPI | - | NPPES |
| 1616827 | Other | IL | BLUE CROSS BLUE SHILED PROVIDER NUMBER |
| 748480 | Other | IL | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 261QF0400X (Illinois) | Primary |
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