ERIE FAMILY HEALTH CENTER INC (NPI# 1043407547) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043407547 |
| Entity Type | Organization |
| Organization Name | ERIE FAMILY HEALTH CENTER INC |
| Other Organization Name | ERIE JOHNSON HEALTH CENTER |
| Practice Address |
1504 S Albany Chicago IL 60623-2209 |
| Mailing Address |
1701 W Superior Chicago IL 60622-5646 |
| Practice Telephone | 3126663494 |
| Practice Fax Number | 3126660610 |
| Mailing Telephone | 3126663494 |
| Mailing Fax Number | 3126660610 |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2020-11-02 |
| Authorized Official Name | LEE FRANCIS (PRESIDENT AND CEO) |
| Authorized Official Telephone | 3124327394 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BLUE CROSS BLUE SHIELD PROVIDE NUMBER | 1616827 | 01 |
| IL | MEDICARE PART B | 748480 | 01 |
| Other Name | Type Code |
|---|---|
| Erie Johnson Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396181590 | Erie Family Health Center Inc | Clinic/Center | 5215 N California Ave Ste F700, Chicago, IL 60625-7014 | 2013-05-14 |
| 1629328836 | Erie Family Health Center Inc | Clinic/Center | 1285 Hartrey, Evanston, IL 60202-1056 | 2012-09-14 |
| 1770900839 | Erie Family Health Center Inc | Clinic/Center | 1701 W Superior St, Chicago, IL 60622-5646 | 2014-03-26 |
| 1851712053 | Erie Family Health Center Inc | Clinic/Center | 1701 W Superior St, Chicago, IL 60622-5646 | 2013-12-16 |
| 1255681383 | Erie Family Health Center Inc | Family Medicine | 1701 W Superior St, Chicago, IL 60622-5646 | 2012-09-17 |
| 1700144243 | Erie Family Health Center Inc | Clinic/Center | 2418 W Division St, Chicago, IL 60622-2940 | 2012-05-02 |
| Street Address |
1504 S ALBANY |
| City | CHICAGO |
| State | IL |
| Zip Code | 60623-2209 |
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| 1992055487 | Margaret C Johnson | Nurse Practitioner | 3860 W. Ogden Ave, Chicago, IL 60623 | 2012-09-12 |
| 1477851319 | Elizabeth Bauer | Physician Assistant | 3256 W 24th St, Chicago, IL 60623 | 2011-03-01 |
| 1023328390 | Rebecca Franco | Advanced Practice Midwife | 2875 W. 19th St, Chicago, IL 60623 | 2010-10-20 |
| 1447580899 | Candace Nicole Hutchen | Pharmacist | 3434 West 13th Place, Chicago, IL 60623 | 2010-01-07 |
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| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.