Provider Demographics
NPI:1902836687
Name:HEALTH CARE ONE SC
Entity Type:Organization
Organization Name:HEALTH CARE ONE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-478-5600
Mailing Address - Street 1:4921 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1921
Mailing Address - Country:US
Mailing Address - Phone:773-478-5600
Mailing Address - Fax:773-478-5602
Practice Address - Street 1:4921 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1921
Practice Address - Country:US
Practice Address - Phone:773-478-5600
Practice Address - Fax:773-478-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDF7575OtherRAILROAD MEDICARE
IL01635073OtherBCBS
IL14D0907680OtherCLIA
IL14D0907680OtherCLIA