Healthcare Provider Details

I. General information

NPI: 1376313791
Provider Name (Legal Business Name): ST BERNARD HOSPITAL & HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 64TH ST
CHICAGO IL
60621-3146
US

IV. Provider business mailing address

PO BOX 809642
CHICAGO IL
60680-8802
US

V. Phone/Fax

Practice location:
  • Phone: 177-396-2404
  • Fax: 773-962-4098
Mailing address:
  • Phone: 630-410-1171
  • Fax: 630-410-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C SPRINGER
Title or Position: CFO
Credential:
Phone: 773-962-4210