| Uic-mshc College Prep Health And Wellness Center | |
|
1231 S Damen Ave Chicago IL 60608-1145 | |
| (312) 243-3741 | |
| (312) 243-0754 |
| Full Name | Uic-mshc College Prep Health And Wellness Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1231 S Damen Ave, Chicago, Illinois |
| Authorized Official Name and Position | Robert Taylor (CFO) |
| Authorized Official Contact | 3124131789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Uic-mshc College Prep Health And Wellness Center 2045 W Washington Blvd Chicago IL 60612-2428 Ph: (312) 413-1789 | Uic-mshc College Prep Health And Wellness Center 1231 S Damen Ave Chicago IL 60608-1145 Ph: (312) 243-3741 |
| NPI Number | 1518194364 |
|---|---|
| Provider Enumeration Date | 06/19/2009 |
| Last Update Date | 06/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518194364 | NPI | - | NPPES |
| 1622185 | Other | IL | BCBC PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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