Provider Demographics
NPI:1184632051
Name:GREENVIEW HEALTH CENTER CHARTERED
Entity Type:Organization
Organization Name:GREENVIEW HEALTH CENTER CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ADALBERTO
Authorized Official - Last Name:OJEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-334-9056
Mailing Address - Street 1:PO BOX 57120
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0120
Mailing Address - Country:US
Mailing Address - Phone:773-334-9056
Mailing Address - Fax:773-334-9009
Practice Address - Street 1:5025 N PAULINA AVE
Practice Address - Street 2:STE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2772
Practice Address - Country:US
Practice Address - Phone:773-334-9056
Practice Address - Fax:773-334-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL010012601OtherMED RR
IL036061009Medicaid
IL003160120OtherBCBC
IL727180Medicare PIN
IL010012601OtherMED RR