NPIMap

Organization Active NPI

Board of Trustees of the University of Illinois

Doing business as UIC-Mile Square Health Center Davis Health and Wellness Center IHH

  • Case Management Agency
  • Chicago, IL
National Provider Identifier
1720555147
Registry record updated Oct 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
UIC-Mile Square Health Center Davis Health and Wellness Center IHH
Practice address
3014 W 39TH PL
Chicago, IL 60632-2402
Phone
(312) 413-1261
NPI assigned
Oct 24, 2018
Last updated
Oct 25, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2018

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

Authorized official

Name
Mr. Henry Taylor
Title
Ceo
Phone
(312) 413-1261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU Primary

Addresses

Primary practice location

3014 W 39TH PL
Chicago, IL 60632-2402

Mailing address

1220 S Wood St
Chicago, IL 60608-1202
Phone (312) 413-1261

Other identifiers 1

IdentifierTypeStateIssuer
1622185OtherILBCBS

Other names 1

  • UIC-Mile Square Health Center Davis Health and Wellness Center IHH Doing business as

National Provider Directory

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

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

3014 W 39th Pl
Chicago, IL 60632
Phone (312) 413-1261

NPI Registry JSON

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540425600000",
    "number": "1720555147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 S WOOD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081202",
            "telephone_number": "312-413-1261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3014 W 39TH PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322402",
            "telephone_number": "312-413-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2018-10-25",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-413-1261",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1622185",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UIC-Mile Square Health Center Davis Health and Wellness Center IHH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 25, 2018; 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.