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PCC COMMUNITY WELLNESS CENTER NPI 1487670097


NPI Information

NPI: 1487670097
Provider Name: PCC COMMUNITY WELLNESS CENTER

Doing Business As: SALUD FAMILY HEALTH CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 14D0940458

Address:
5359 E FULLERTON AVE
CHICAGO, IL
ZIP 60639
Phone: (773) 836-2785
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PCC COMMUNITY WELLNESS CENTER is a federally qualified health center (fqhc) clinic center in Chicago, IL. PCC COMMUNITY WELLNESS CENTER NPI is 1487670097. The provider is registered as an organization entity type.
The provider Is Doing Business As Salud Family Health Center.

The provider's business location address is:

5359 E FULLERTON AVE
CHICAGO, IL
ZIP 60639-450
Phone: (773) 836-2785
Fax: (773) 836-7381

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 14D0940458 - community clinic 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 8/26/2008.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)=========003ILLINOISYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1141032OTHERMEDICARE PART A PROVIDER NUMBER
2=========003MEDICAIDILLINOIS
3211315MEDICARE ID-TYPE UNSPECIFIEDGROUP
4328570MEDICARE ID-TYPE UNSPECIFIEDGROUP

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: 11/14/2023

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