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1111 Superior St Suite 207 Melrose Park IL 60160-4138 | |
| (708) 406-3040 | |
| (708) 406-3059 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1111 Superior St, Melrose Park, Illinois |
| Authorized Official Name and Position | Robert J Urso (PRESIDENT AND CEO) |
| Authorized Official Contact | 7083839786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1111 Superior St Suite 207 Melrose Park IL 60160-4138 Ph: (708) 406-3040 | 1111 Superior St Suite 207 Melrose Park IL 60160-4138 Ph: (708) 406-3040 |
| NPI Number | 1720104573 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1557270139 |
|---|---|
| Medicare Enrollment ID | O20081121000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720104573 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 011 (Illinois) | Primary |
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