Healthcare Provider Details

I. General information

NPI: 1871581314
Provider Name (Legal Business Name): MOUNT SINAI HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE
CHICAGO IL
60608-1782
US

IV. Provider business mailing address

26467 NETWORK PL
CHICAGO IL
60673-1264
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-2000
  • Fax:
Mailing address:
  • Phone: 773-542-2000
  • Fax: 773-257-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5229
License Number StateIL

VIII. Authorized Official

Name: MR. GARY KRUGEL
Title or Position: CFO
Credential:
Phone: 772-257-6642