Healthcare Provider Details

I. General information

NPI: 1275704124
Provider Name (Legal Business Name): MCGAW MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST SUITE 18-200
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

675 N SAINT CLAIR ST SUITE 18-200
CHICAGO IL
60611-5975
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberAN5240394-9871
License Number StateIL

VIII. Authorized Official

Name: DIANE WAYNE
Title or Position: PROGRAM DIRECTOR
Credential: M.D.
Phone: 312-695-8630