Provider Demographics
NPI:1417341249
Name:ALIVIO MEDICAL CENTER-JUAREZ HIGH SCHOOL
Entity Type:Organization
Organization Name:ALIVIO MEDICAL CENTER-JUAREZ HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:312-829-6304
Mailing Address - Street 1:2355 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3837
Mailing Address - Country:US
Mailing Address - Phone:773-254-1400
Mailing Address - Fax:312-733-3563
Practice Address - Street 1:1450 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4408
Practice Address - Country:US
Practice Address - Phone:773-254-1400
Practice Address - Fax:312-733-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL771115088207Q00000X, 208000000X
IL771115008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid
ILPENDINGMedicare PIN