Healthcare Provider Details

I. General information

NPI: 1700635190
Provider Name (Legal Business Name): ST BERNARD HOSPITAL & HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 S STEWART AVE
CHICAGO IL
60621-3116
US

IV. Provider business mailing address

326 W 64TH ST
CHICAGO IL
60621-3114
US

V. Phone/Fax

Practice location:
  • Phone: 773-420-1573
  • Fax: 773-420-1851
Mailing address:
  • Phone: 773-962-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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