MEDICARE: PERPETUAL HELP MEDICAL CENTER, INC.

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	261Q00000X	Clinic/Center	58480681	IL

General Provider Information

NPI Number	:	1255530796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERPETUAL HELP MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5524 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1406
Country	:	US
Telephone Number	:	773-271-2350
Fax Number	:	773-271-8521

Provider Business Practice Location Address
First Line	:	5524 N BROADWAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1406
Country	:	US
Telephone Number	:	773-271-2350
Fax Number	:	773-271-8521

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. YOLANDA E BELGA
Credential	:	RN
Telephone Number	:	773-271-2350

Provider Enumeration Date	:	07/14/2007
Last Update Date	:	08/10/2009

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