MEDICARE: MOUNT SINAI COMMUNITY FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		IL
2	207R00000X	Internal Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5783350002	OTHER	IL	DME NUMBER

General Provider Information

NPI Number	:	1225125677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI COMMUNITY FOUNDATION

Provider Business Mailing Address
First Line	:	3537 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0035
Country	:	US
Telephone Number	:	708-786-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3935
Country	:	US
Telephone Number	:	773-722-2712
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. JOHN E VAZQUEZ
Credential	:	M.D.
Telephone Number	:	773-257-6850

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/21/2022

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Directions to “MOUNT SINAI COMMUNITY FOUNDATION ” Practice Location

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