Provider Demographics
NPI:1639111933
Name:ADVOCATE HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:ADVOCATE HEALTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-7117
Mailing Address - Street 1:2311 W 22ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2545 S KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2441
Practice Address - Country:US
Practice Address - Phone:312-842-7117
Practice Address - Fax:312-326-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA1606OtherMEDICARE RAILROAD GROUP #
IL1633717OtherBCBS HMOI PROVIDER #
IL21621975OtherBCBS PROVIDER ID #
IL215289OtherMEDICARE LOC.15 GROUP #
IL205576Medicare ID - Type UnspecifiedGROUP NUMBER
IL205575Medicare ID - Type UnspecifiedGROUP NUMBER
IL21621975OtherBCBS PROVIDER ID #
IL209399Medicare ID - Type UnspecifiedGROUP NUMBER