Provider Demographics
NPI:1609264001
Name:ALIVIO MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:ALIVIO MEDICAL CENTER, INC.
Other - Org Name:ALIVIO'S WALK IN WELLNESS CENTER AT BERWYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-829-6304
Mailing Address - Street 1:966 W 21ST ST
Mailing Address - Street 2:
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:773-650-1239
Practice Address - Street 1:6447 CERMAK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2311
Practice Address - Country:US
Practice Address - Phone:773-254-1400
Practice Address - Fax:773-650-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========015Medicaid
ILPENDINGMedicare Oscar/Certification