Provider Demographics
NPI:1881968501
Name:CITY OF CHICAGO
Entity type:Organization
Organization Name:CITY OF CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRST DEPUTY COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-747-9878
Mailing Address - Street 1:2861 NORTH CLARK STREET
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:312-744-5507
Mailing Address - Fax:312-744-9359
Practice Address - Street 1:2861 N CLARK ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5207
Practice Address - Country:US
Practice Address - Phone:312-744-5507
Practice Address - Fax:312-744-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEMPLOYER'S IDENTIFICATION NUMBER