| Pcc Community Wellness Center | |
|
14 W Lake St Oak Park IL 60302-2606 | |
| (708) 383-0113 | |
| (708) 383-9911 |
| Full Name | Pcc Community Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 14 W Lake St, Oak Park, Illinois |
| Authorized Official Name and Position | Robert J Urso (PRESIDENT & CEO) |
| Authorized Official Contact | 7083839786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pcc Community Wellness Center 14 W Lake St Oak Park IL 60302-2606 Ph: (708) 383-0113 | Pcc Community Wellness Center 14 W Lake St Oak Park IL 60302-2606 Ph: (708) 383-0113 |
| NPI Number | 1073536991 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1557270139 |
|---|---|
| Medicare Enrollment ID | O20081121000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073536991 | NPI | - | NPPES |
| 141888 | Other | MEDICARE PART A PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 001 (Illinois) | Primary |
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