PCC COMMUNITY WELLNESS CENTER NPI 1164628012

NPI Information

PCC COMMUNITY WELLNESS CENTER is a federally qualified health center (fqhc) clinic center in Chicago, IL. PCC COMMUNITY WELLNESS CENTER NPI is 1164628012. The provider is registered as an organization entity type.
The provider Is Doing Business As Pcc West Town Family Health Center.

The provider's business location address is:

2434 W DIVISION ST
CHICAGO, IL
ZIP 60622-942
Phone: (773) 292-8300
Fax: (708) 292-2601

The provider's authorized official is Robert J Urso .
The authorized official title is President - Chief Executive Officer and has the following contact phone number (708) 383-9786.

The CLIA number assigned to this NPI record is 14D1079152 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/26/2007 and was last updated on 3/5/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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