PCC COMMUNITY WELLNESS CENTER NPI 1174549786

NPI Information

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 7/14/2011.

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

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