Healthcare Provider Details

I. General information

NPI: 1841333788
Provider Name (Legal Business Name): LITTLE COMPANY OF MARY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SOUTHWEST HWY
OAK LAWN IL
60453-3617
US

IV. Provider business mailing address

9800 SOUTHWEST HWY
OAK LAWN IL
60453-3617
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-4663
  • Fax: 708-499-5975
Mailing address:
  • Phone: 708-229-4663
  • Fax: 708-499-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY FREYER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 708-229-5004