Provider Demographics
NPI:1952035123
Name:NEAR NORTH HEALTH SERVICE CORPORATION
Entity Type:Organization
Organization Name:NEAR NORTH HEALTH SERVICE CORPORATION
Other - Org Name:NEAR NORTH HEALTH CORPORATION MOBILE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MVUDUDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-337-1073
Mailing Address - Street 1:1276 N CLYBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2003
Mailing Address - Country:US
Mailing Address - Phone:331-643-5238
Mailing Address - Fax:312-337-1794
Practice Address - Street 1:1276 N CLYBOURN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2003
Practice Address - Country:US
Practice Address - Phone:312-337-1073
Practice Address - Fax:312-337-5264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEAR NORTH HEALTH SERVICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-13
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatricsGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty