NEAR NORTH HEALTH SERVICE CORPORATION NPI 1821079088

NPI Information

NEAR NORTH HEALTH SERVICE CORPORATION is a federally qualified health center (fqhc) clinic center in Chicago, IL. NEAR NORTH HEALTH SERVICE CORPORATION NPI is 1821079088. The provider is registered as an organization entity type.
The provider Is Doing Business As Winfield Moody Health Center.

The provider's business location address is:

1276 N CLYBOURN AVE
CHICAGO, IL
ZIP 60610-089
Phone: (312) 337-1073
Fax: (312) 337-7616

The provider's authorized official is Berneice Mills-thomas .
The authorized official title is Executive Director and has the following contact phone number (312) 337-1073.

The CLIA number assigned to this NPI record is 14D0706274 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/7/2005 and was last updated on 7/26/2021.

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:

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