Healthcare Provider Details

I. General information

NPI: 1629147210
Provider Name (Legal Business Name): ST BERNARD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 W 64TH ST ST. BERNARD HOSPITAL - ANESTHESIA DEPARTMENT
CHICAGO IL
60621-3114
US

IV. Provider business mailing address

520 E 22ND ST
LOMBARD IL
60148-6110
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-4100
  • Fax:
Mailing address:
  • Phone: 630-874-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH VAN STRATEN
Title or Position: CEO
Credential:
Phone: 773-962-4100