Provider Demographics
NPI:1245232628
Name:CITY OF CHICAGO
Entity Type:Organization
Organization Name:CITY OF CHICAGO
Other - Org Name:CHICAGO DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRST DEPUTY COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-747-9889
Mailing Address - Street 1:333 S STATE ST
Mailing Address - Street 2:REVENUE #200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3900
Mailing Address - Country:US
Mailing Address - Phone:312-747-9443
Mailing Address - Fax:312-747-9447
Practice Address - Street 1:2418 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2940
Practice Address - Country:US
Practice Address - Phone:312-744-0943
Practice Address - Fax:312-744-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health