| Esperanza 63rd St. | |
|
4058 W 63rd St Chicago IL 60629-4639 | |
| (773) 584-6200 | |
| (844) 285-1003 |
| Full Name | Esperanza 63rd St. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4058 W 63rd St, Chicago, Illinois |
| Authorized Official Name and Position | Zachary Spreitzer (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 7736405785 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Esperanza 63rd St. 1940 S Western Ave Suite 205 Chicago IL 60608-2503 Ph: (773) 584-6200 | Esperanza 63rd St. 4058 W 63rd St Chicago IL 60629-4639 Ph: (773) 584-6200 |
| NPI Number | 1407458946 |
|---|---|
| Provider Enumeration Date | 11/10/2020 |
| Last Update Date | 08/02/2023 |
| Medicare PECOS PAC ID | 2961453105 |
|---|---|
| Medicare Enrollment ID | O20220914000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407458946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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