1205923539 NPI number — PRESENCE CHICAGO HOSPITALS NETWORK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205923539 NPI number — PRESENCE CHICAGO HOSPITALS NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE CHICAGO HOSPITALS NETWORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRESENCE RESURRECTION MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205923539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES PLAINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60016-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-813-3666
Provider Business Mailing Address Fax Number:
847-813-3681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7435 W TALCOTT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60631-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-774-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEUMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
224-273-0516

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0269 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363330926001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".