| City Of Chicago | |
|
111 W Washington St Fl 4 Chicago IL 60602-2703 | |
| (312) 747-9884 | |
| (312) 747-9447 |
| Full Name | City Of Chicago |
|---|---|
| Speciality | Clinic/Center |
| Location | 111 W Washington St Fl 4, Chicago, Illinois |
| Authorized Official Name and Position | Tyanna Qualls (PROJECTS ADMINISTRATOR) |
| Authorized Official Contact | 3127472203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| City Of Chicago 111 W Washington St Fl 4 Chicago IL 60602-2703 Ph: (312) 747-9443 | City Of Chicago 111 W Washington St Fl 4 Chicago IL 60602-2703 Ph: (312) 747-9884 |
| NPI Number | 1194725192 |
|---|---|
| Provider Enumeration Date | 08/01/2005 |
| Last Update Date | 11/14/2024 |
| Medicare PECOS PAC ID | 4486540929 |
|---|---|
| Medicare Enrollment ID | O20040303001160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194725192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Illinois) | Primary |
| Provider Name | Nancy L Gajewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538256276 PECOS PAC ID: 6901990860 Enrollment ID: I20070922000048 |
| Provider Name | Shilynda S Tolbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558334532 PECOS PAC ID: 6204923808 Enrollment ID: I20071029000736 |
| Provider Name | Angela B Sims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083680797 PECOS PAC ID: 8729121959 Enrollment ID: I20100216000242 |
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