| Haymarket Center | |
|
124 N Sangamon St Chicago IL 60607-2202 | |
| (312) 226-7984 | |
| (312) 226-8048 |
| Full Name | Haymarket Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 N Sangamon St, Chicago, Illinois |
| Authorized Official Name and Position | Gigi Fuller (DIRECTOR OF QA) |
| Authorized Official Contact | 3122267984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haymarket Center 932 W Washington Blvd Chicago IL 60607-2217 Ph: (312) 226-7984 | Haymarket Center 124 N Sangamon St Chicago IL 60607-2202 Ph: (312) 226-7984 |
| NPI Number | 1457004046 |
|---|---|
| Provider Enumeration Date | 02/02/2022 |
| Last Update Date | 06/13/2023 |
| Medicare PECOS PAC ID | 7517354178 |
|---|---|
| Medicare Enrollment ID | O20220428002128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457004046 | NPI | - | NPPES |
| Provider Name | Mary E Fry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801996368 PECOS PAC ID: 0446213888 Enrollment ID: I20041108000392 |
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