Healthcare Provider Details

I. General information

NPI: 1467922005
Provider Name (Legal Business Name): ST BERNARD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 64TH ST
CHICAGO IL
60621-3114
US

IV. Provider business mailing address

326 W 64TH ST
CHICAGO IL
60621-3114
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-4210
  • Fax:
Mailing address:
  • Phone: 773-962-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

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