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NPI Code Detail

MEDICARE: VISTA HEALTH D/B/A ST. THERESE MEDICAL CENTER

MEDICARE: VISTA HEALTH D/B/A ST. THERESE MEDICAL CENTER
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1457300311
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA HEALTH D/B/A ST. THERESE MEDICAL CENTER
Provider Business Mailing Address
First Line : 60 S GREENLEAF ST
Second Line :
City : GURNEE
State : IL
Zip : 60031-3300
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 60 S GREENLEAF ST
Second Line :
City : GURNEE
State : IL
Zip : 60031-3300
Country : US
Telephone Number : 847-360-1674
Fax Number :
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : BARBARA J. MARTIN
Credential :
Telephone Number : 847-360-3000
Provider Enumeration Date : 05/09/2006
Last Update Date : 08/22/2020

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