HUMBOLDT PARK HEALTH NPI 1619146867

NPI Information

HUMBOLDT PARK HEALTH is a clinic center in Chicago, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). HUMBOLDT PARK HEALTH NPI is 1619146867. The provider is registered as an organization entity type.
The provider Is Doing Business As Prohealth Medical Center.

The provider's business location address is:

1044 N FRANCISCO AVE
CHICAGO, IL
ZIP 60622-743
Phone: (773) 292-8200
Fax: (773) 278-3899

The provider's authorized official is Dorothy Cheryl Erins .
The authorized official title is Credentialing Specialist and has the following contact phone number (269) 244-5256.

The CLIA number assigned to this NPI record is 14D0043438 - hospital with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 2/21/2008 and was last updated on 1/27/2021.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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