The Board of Trustees of the University of Illinois

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Doing business as

Mile Square- IHC Thresholds Mothers Program

Practice address

1110 W Belmont Ave
Ihc Thresholds Mothers Program
Chicago, IL 60657-3313

Phone

(312) 996-9354

Fax

(312) 996-7725

NPI assigned

Sep 20, 2007

Last updated

Aug 5, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. William R Nicolas, PHD

Title

Executive Director Uic Medical Pla

Phone

(312) 413-0573

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mile Square- IHC Thresholds Mothers Program Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217894400000",
    "number": "1205022506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W BELMONT AVE",
            "address_2": "IHC THRESHOLDS MOTHERS PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573313",
            "telephone_number": "312-996-9354",
            "fax_number": "312-996-7725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 W BELMONT AVE",
            "address_2": "IHC THRESHOLDS MOTHERS PROGRAM",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573313",
            "telephone_number": "312-996-9354",
            "fax_number": "312-996-7725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2008-08-05",
        "status": "A",
        "authorized_official_last_name": "NICOLAS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR UIC MEDICAL PLA",
        "authorized_official_telephone_number": "312-413-0573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CERTIFICATION",
            "identifier": "14-1073",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Square- IHC Thresholds Mothers Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Board of Trustees of the University of Illinois (UIC Physician Group)
• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois (University of Illinois Hospital and Clinics)
• The Board of Trustees of the University of Illinois (College of Applied Health Sciences Faculty Practice)
• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois (UIC Sleep Science Center)
• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois
• The Board of Trustees of the University of Illinois (Uic - MSHC Near West Family Center)

• Federally Qualified Health Center (FQHC) in Chicago, IL
• Providers in Chicago, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.