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4630 South Bishop Street Uih-mile Square Health Center At Back Of The Yards Chicago IL 60609-3240 | |
| (773) 579-9401 | |
| (312) 413-7812 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4630 South Bishop Street, Chicago, Illinois |
| Authorized Official Name and Position | Henry Taylor (CEO) |
| Authorized Official Contact | 3124131261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1220 S. Wood Street Uih-mile Square Health Center Chicago IL 60608-1202 Ph: (312) 413-1261 | 4630 South Bishop Street Uih-mile Square Health Center At Back Of The Yards Chicago IL 60609-3240 Ph: (773) 579-9401 |
| NPI Number | 1457523219 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 12/17/2015 |
| Medicare PECOS PAC ID | 3072422716 |
|---|---|
| Medicare Enrollment ID | O20080519000477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457523219 | NPI | - | NPPES |
| 1622185 | Other | IL | BCBS PROVIDER |
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