Provider Demographics
NPI:1457004046
Name:MCDERMOTT CENTER
Entity Type:Organization
Organization Name:MCDERMOTT CENTER
Other - Org Name:HAYMARKET CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:312-226-7984
Mailing Address - Street 1:932 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2217
Mailing Address - Country:US
Mailing Address - Phone:312-226-7984
Mailing Address - Fax:312-226-8048
Practice Address - Street 1:124 N SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2202
Practice Address - Country:US
Practice Address - Phone:312-226-7984
Practice Address - Fax:312-226-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty