1023182177 NPI number — ADVOCATE CHRIST MEDICAL CENTER

Table of content: JASON SCOTT ITZ CI (NPI 1598267767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023182177 NPI number — ADVOCATE CHRIST MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCATE CHRIST MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1023182177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12454 MACKINAC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMER GLEN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60491-8408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-301-6441
Provider Business Mailing Address Fax Number:
708-590-6466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 W 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-684-8000
Provider Business Practice Location Address Fax Number:
708-684-1028
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCCREARY
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
ATTENDING PHYSICIAN
Authorized Official Telephone Number:
708-684-8000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  00303605724901 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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