ALIVIO MEDICAL CENTER, INC.

Provider Demographics

• NPI: 1083860845
• Name: ALIVIO MEDICAL CENTER, INC.
• Entity Type: Organization
• Organization Name: ALIVIO MEDICAL CENTER, INC.
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: ESTHER
• Authorized Official - Last Name: CORPUZ
• Authorized Official - Phone: 312-829-6304
• Mailing Address - Street 1: 966 W 21ST ST
• Mailing Address - City: CHICAGO
• Mailing Address - State: IL
• Mailing Address - Zip Code: 60608-4511
• Mailing Address - Country: US
• Mailing Address - Phone: 773-254-1400
• Mailing Address - Fax: 312-829-6843
• Practice Address - Street 1: ALIVIO MEDICAL CTR
• Practice Address - Street 2: 75 REMITTANCE DR. SUITE 6577
• Practice Address - City: CHICAGO
• Practice Address - State: IL
• Practice Address - Zip Code: 60675-6577
• Practice Address - Country: US
• Practice Address - Phone: 312-829-6327
• Practice Address - Fax: 312-829-6843
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-08-13
• Last Update Date: 2014-08-19

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty
No	251300000X	Agencies	Local Education Agency (LEA)
No	261QD0000X	Ambulatory Health Care Facilities	Clinic/Center	Dental
No	261QF0400X	Ambulatory Health Care Facilities	Clinic/Center	Federally Qualified Health Center (FQHC)

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IL	920890	Other	MEDICARE PART B TPAN
IL	036100871 3	Medicaid
IL	141077	Other	TPAN
IL	036118630 1	Medicaid
IL	0001618612	Other	BCBS
IL	036113015 3	Medicaid
IL	036118630 1	Medicaid
IL	920890	Medicare Oscar/Certification
IL	=========001	Medicaid
IL	=========009	Medicaid
IL	=========005	Medicaid
IL	920890	Medicare Oscar/Certification
IL	=========007	Medicaid
IL	0001618612	Other	BCBS
IL	036118630 1	Medicaid
IL	=========006	Medicaid