1679660906 NPI number — PRESENCE CHICAGO HOSPITALS NETWORK

Table of content: (NPI 1679660906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679660906 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-DIALYSIS
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:
1679660906
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: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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".




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