Healthcare Provider Details

I. General information

NPI: 1427329226
Provider Name (Legal Business Name): EDWARD HINES JR. VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

24124 W EDWIN CT
CHANNAHON IL
60410-5248
US

V. Phone/Fax

Practice location:
  • Phone: 708-217-2422
  • Fax:
Mailing address:
  • Phone: 815-685-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number242.001998
License Number StateIL

VIII. Authorized Official

Name: DR. LINDA J SHEU
Title or Position: PHYSICIAN
Credential: MD
Phone: 312-343-3828