Healthcare Provider Details

I. General information

NPI: 1124322680
Provider Name (Legal Business Name): ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 203RD ST
OLYMPIA FIELDS IL
60461-1180
US

IV. Provider business mailing address

1040 SIERRA DR SUITE 400
GREENWOOD IN
46143-7240
US

V. Phone/Fax

Practice location:
  • Phone: 708-709-6295
  • Fax:
Mailing address:
  • Phone: 317-528-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS SENESAC
Title or Position: TREASURER
Credential:
Phone: 708-756-1000