PCC COMMUNITY WELLNESS CENTER NPI 1174549786

NPI Information

NPI: 1174549786
Provider Name: PCC COMMUNITY WELLNESS CENTER
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
Doing Business As: SOUTH FAMILY HEALTH CENTER
CLIA Number: 14D1052566
Address: 6201 ROOSEVELT RD
BERWYN, IL
ZIP 60402
Phone: (708) 386-0845

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NPI Details

PCC COMMUNITY WELLNESS CENTER is a federally qualified health center (fqhc) clinic center in Berwyn, IL. PCC COMMUNITY WELLNESS CENTER NPI is 1174549786. The provider is registered as an organization entity type.
The provider Is Doing Business As South Family Health Center.

The provider's business location address is:

6201 ROOSEVELT RD
BERWYN, IL
ZIP 60402-108
Phone: (708) 386-0845
Fax: (708) 386-8472

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

The CLIA number assigned to this NPI record is 14D1052566 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/15/2006 and was last updated on 7/21/2022.

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)	005	ILLINOIS	Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	141031	OTHER	ILLINOIS	MEDICARE PROVIDER ID

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: 3/30/2025

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