NPIMap

Organization Active NPI

Mile Square Davis/Brighton Park Satellite Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1497293344
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MILE SQUARE DAVIS/BRIGHTON PARK SATELLITE HEALTH AND WELLNESS CENTER
Practice address
3825 S Washtenaw Ave
Chicago, IL 60632-1633
Phone
(773) 376-5293
NPI assigned
Feb 10, 2017
Last updated
Sep 4, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Authorized official

Name
Mr. Henry Taylor
Title
Executive Director
Phone
(312) 412-1261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

3825 S Washtenaw Ave
Chicago, IL 60632-1633

Mailing address

3825 S Washtenaw Ave
Chicago, IL 60632-1633
Phone (773) 376-5293

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one
Part of
Uic Dept of Pathology

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3825 S Washtenaw Ave
Chicago, IL 60632
Phone (773) 376-5293

NPI Registry JSON

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

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567555200000",
    "number": "1497293344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 S WASHTENAW AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606321633",
            "telephone_number": "773-376-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 S WASHTENAW AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606321633",
            "telephone_number": "773-376-5293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE SQUARE DAVIS/BRIGHTON PARK SATELLITE HEALTH AND WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "enumeration_date": "2017-02-10",
        "last_updated": "2019-09-04",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "312-412-1261",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; 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.