PCC COMMUNITY WELLNESS CENTER NPI 1871516799

NPI Information

NPI: 1871516799
Provider Name: PCC COMMUNITY WELLNESS CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 14D0855629

Address:
14 LAKE ST
OAK PARK, IL
ZIP 60302
Phone: (708) 383-0113
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PCC COMMUNITY WELLNESS CENTER is a federally qualified health center (fqhc) clinic center in Oak Park, IL. PCC COMMUNITY WELLNESS CENTER NPI is 1871516799. The provider is registered as an organization entity type.

The provider's business location address is:

14 LAKE ST
OAK PARK, IL
ZIP 60302-606
Phone: (708) 383-0113
Fax: (708) 383-1378

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

The CLIA number assigned to this NPI record is 14D0855629 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/25/2006 and was last updated on 8/22/2020.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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