1265454391 NPI number — PRESENCE CENTRAL AND SUBURBAN 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 1265454391 NPI number — PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENCE CENTRAL AND SUBURBAN 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 MERCY 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:
1265454391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60506-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-859-2222
Provider Business Mailing Address Fax Number:
630-859-9014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60506-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-859-2222
Provider Business Practice Location Address Fax Number:
630-859-9014
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
AMITA CFO
Authorized Official Telephone Number:
224-273-2350

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  ID NUMBER 0004903 , 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)

  • Identifier: 1012 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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