Provider Demographics
NPI:1073659280
Name:EVANSTON TOWNSHIP HIGH SCHOOL HEALTH CENTER
Entity Type:Organization
Organization Name:EVANSTON TOWNSHIP HIGH SCHOOL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTWOUT
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:847-424-7265
Mailing Address - Street 1:1600 DODGE AVE
Mailing Address - Street 2:ROOM H-101
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3449
Mailing Address - Country:US
Mailing Address - Phone:847-424-7265
Mailing Address - Fax:847-492-5809
Practice Address - Street 1:1600 DODGE AVE
Practice Address - Street 2:ROOM H-101
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3449
Practice Address - Country:US
Practice Address - Phone:847-424-7265
Practice Address - Fax:847-492-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366004393002Medicaid