MEDICARE: SAINT JOSEPH 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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1942414131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH HOSPITAL

Provider Business Mailing Address
First Line	:	2900 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5640
Country	:	US
Telephone Number	:	773-665-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	528 W WELLINGTON AVE
Second Line	:	APT #302
City	:	CHICAGO
State	:	IL
Zip	:	60657-5413
Country	:	US
Telephone Number	:	773-678-5449
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD E. STRUXNESS
Credential	:
Telephone Number	:	773-665-3000

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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