Basic Information
| Provider Information | |||||||||
| NPI: | 1639111933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATE HEALTH CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 W 22ND ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231225 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2545 S KING DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128427117 | ||||||||
| FaxNumber: | 3123262102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 11/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3128427117 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | DA1606 | 01 | IL | MEDICARE RAILROAD GROUP # | OTHER | 1633717 | 01 | IL | BCBS HMOI PROVIDER # | OTHER | 21621975 | 01 | IL | BCBS PROVIDER ID # | OTHER | 215289 | 01 | IL | MEDICARE LOC.15 GROUP # | OTHER |