| Mile Square-ihc Thresholds South | |
|
734 W 47th St Chicago IL 60609-4411 | |
| (312) 996-9354 | |
| (312) 996-7725 |
| Full Name | Mile Square-ihc Thresholds South |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 734 W 47th St, Chicago, Illinois |
| Authorized Official Name and Position | William R. Nicholas (EXECUTIVE DIRECTOR UIC MEDICAL PLAN) |
| Authorized Official Contact | 3124130573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mile Square-ihc Thresholds South 734 W 47th St Chicago IL 60609-4411 Ph: (312) 996-9354 | Mile Square-ihc Thresholds South 734 W 47th St Chicago IL 60609-4411 Ph: (312) 996-9354 |
| NPI Number | 1598879819 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 08/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598879819 | NPI | - | NPPES |
| 01634874 | Other | IL | BC/BS |
| 14-1072 | Other | IL | MEDICARE CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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