Healthcare Provider Details

I. General information

NPI: 1013004266
Provider Name (Legal Business Name): SILVER CROSS MANAGED CARE ORGANIZATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAPLE RD
JOLIET IL
60432-1439
US

IV. Provider business mailing address

1200 MAPLE RD
JOLIET IL
60432-1439
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-7118
  • Fax: 815-740-7901
Mailing address:
  • Phone: 815-740-7118
  • Fax: 815-740-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM BROWNLOW
Title or Position: SR. VICE PRESIDENT FINANCE
Credential:
Phone: 815-740-7007