| Mile Square- Ihc Thresholds Mothers Program | |
|
1110 W Belmont Ave Ihc Thresholds Mothers Program Chicago IL 60657-3313 | |
| (312) 996-9354 | |
| (312) 996-7725 |
| Full Name | Mile Square- Ihc Thresholds Mothers Program |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1110 W Belmont Ave, Chicago, Illinois |
| Authorized Official Name and Position | William R Nicolas (EXECUTIVE DIRECTOR UIC MEDICAL PLA) |
| Authorized Official Contact | 3124130573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mile Square- Ihc Thresholds Mothers Program 1110 W Belmont Ave Ihc Thresholds Mothers Program Chicago IL 60657-3313 Ph: (312) 996-9354 | Mile Square- Ihc Thresholds Mothers Program 1110 W Belmont Ave Ihc Thresholds Mothers Program Chicago IL 60657-3313 Ph: (312) 996-9354 |
| NPI Number | 1205022506 |
|---|---|
| Provider Enumeration Date | 09/20/2007 |
| Last Update Date | 08/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205022506 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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