1447571013 NPI number — LOYOLA UNIVERSITY HOSPITAL SYSTEM

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 1447571013 NPI number — LOYOLA UNIVERSITY HOSPITAL SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOYOLA UNIVERSITY HOSPITAL SYSTEM
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:
1447571013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1041 SUSAN COLLINS LN APT 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302-5412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 SUSAN COLLINS LN APT 501
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-506-5749
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF INT MEDICINE RESIDENCY
Authorized Official Telephone Number:
708-216-6497

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  125057873 , 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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