1932121860 NPI number — FRANCISCAN HEALTH OLYMPIA FIELDS

Table of content: (NPI 1932121860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932121860 NPI number — FRANCISCAN HEALTH OLYMPIA FIELDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANCISCAN HEALTH OLYMPIA FIELDS
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:
1932121860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16149 CLINTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60426-5908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-848-2159
Provider Business Mailing Address Fax Number:
708-331-3285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16149 CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-848-2159
Provider Business Practice Location Address Fax Number:
708-331-3285
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WESSEL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISIONAL CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
317-705-4530

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  69000867A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 203.000313 , 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: 100019640 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: N272573 . This is a "HARMONY HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1632168 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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