South Shore School of Leadership Health Center

Primary specialty

Student Health Clinic/CenterTaxonomy code 261QS1000X

License

042617358 Issued in IL

Legal business name

SOUTH SHORE SCHOOL OF LEADERSHIP HEALTH CENTER

Practice address

7627 S Constance Ave
Chicago, IL 60649-4009

Phone

(773) 535-7406

Fax

(312) 808-0655

NPI assigned

Oct 22, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Peter Friedell, M.D.

Title

President

Phone

(312) 808-0621

Specialties & licenses 1

Addresses

Other names 1

• Friedell Primary Care Doing business as

Tax ID family

South Shore School of Leadership Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pef Clinic II LTD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1245542356
  NPD tax ID
• Pef Clinic II, LTD.

  • Student Health Clinic/Center
  • Chicago, IL
  • NPI 1407284664
  NPD tax ID

Locations

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1508294091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 S WABASH AVE",
            "address_2": "SUITE 203",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162955",
            "telephone_number": "312-808-0621",
            "fax_number": "312-808-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7627 S CONSTANCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606494009",
            "telephone_number": "773-535-7406",
            "fax_number": "312-808-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE SCHOOL OF LEADERSHIP HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-22",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "FRIEDELL",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-808-0621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "IL",
            "license": "042617358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friedell Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Shore Hospital Corporation
• South Shore Hospital Corporation
• South Shore Lake Front Services, Inc
• South Shore Med & Rehab Center
• South Shore Radiologists, S.C.
• South Side Healthy Community Organization, Inc
• South Side Help Center
• South Side Medical Group LTD.
• South Side Pharmacy, Inc.
• South Suburban Health Professionals PC

• Student Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Student Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; 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.