Provider Demographics
NPI:1033838214
Name:NEAR NORTH HEALTH SERVICE CORPORATION
Entity Type:Organization
Organization Name:NEAR NORTH HEALTH SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-337-1073
Mailing Address - Street 1:1276 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2003
Mailing Address - Country:US
Mailing Address - Phone:331-643-5238
Mailing Address - Fax:
Practice Address - Street 1:1276 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2003
Practice Address - Country:US
Practice Address - Phone:331-643-5238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No174200000XOther Service ProvidersMeals
No251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health