Healthcare Provider Details

I. General information

NPI: 1942084538
Provider Name (Legal Business Name): MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S. ROUTE 31 STE 1-100L
CRYSTAL LAKE IL
60014-8190
US

IV. Provider business mailing address

875 S. ROUTE 31 STE 1-100L
CRYSTAL LAKE IL
60014-8190
US

V. Phone/Fax

Practice location:
  • Phone: 779-220-5200
  • Fax: 779-220-5325
Mailing address:
  • Phone: 779-220-5200
  • Fax: 779-220-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH D MALAS
Title or Position: VP CFO
Credential:
Phone: 815-971-6738