MEDICARE: MT. SINAI HOSPITAL

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	282NC2000X	Children's Hospital	25056316	IL

General Provider Information

NPI Number	:	1285946293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. SINAI HOSPITAL

Provider Business Mailing Address
First Line	:	15 CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 CALIFORNIA AVE.
Second Line	:	F 444
City	:	CHICAGO
State	:	IL
Zip	:	60608-3640
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM CHAIRMAN AND DIRECTOR
Name	:	DR. DENNIS VICKERS
Credential	:	M.D.
Telephone Number	:	773-257-6300

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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