Provider Demographics
NPI:1649324211
Name:SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION
Entity type:Organization
Organization Name:SIDNEY HILLMAN HEALTH CENTRE OF THE CHICAGO AND CENT ST JNT BRD UNION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-738-6196
Mailing Address - Street 1:333 S ASHLAND AVE
Mailing Address - Street 2:FOURTH AND FIFTH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2703
Mailing Address - Country:US
Mailing Address - Phone:312-738-6170
Mailing Address - Fax:312-942-1554
Practice Address - Street 1:333 S ASHLAND AVE
Practice Address - Street 2:FOURTH AND FIFTH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2703
Practice Address - Country:US
Practice Address - Phone:312-738-6170
Practice Address - Fax:312-942-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649324211OtherNPI