Healthcare Provider Details

I. General information

NPI: 1023262441
Provider Name (Legal Business Name): ADVOCATE CONDELL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N HUNT CLUB RD
GURNEE IL
60031-2656
US

IV. Provider business mailing address

900 GARFIELD AVE
LIBERTYVILLE IL
60048-3141
US

V. Phone/Fax

Practice location:
  • Phone: 847-599-7365
  • Fax:
Mailing address:
  • Phone: 847-362-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number0000422
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number0000422
License Number StateIL

VIII. Authorized Official

Name: MR. DAVID CARTWRIGHT
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 847-990-5205