1558517896 NPI number — ST. JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE

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 1558517896 NPI number — ST. JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
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:
6
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:
1558517896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1423 CHICAGO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60411-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-756-1000
Provider Business Mailing Address Fax Number:
708-755-3392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19110 DAVIN DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-756-1000
Provider Business Practice Location Address Fax Number:
708-755-3392
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BANDA
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, FINANCE
Authorized Official Telephone Number:
708-756-1000

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  1744997 , 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: 140172 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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