Healthcare Provider Details

I. General information

NPI: 1235450388
Provider Name (Legal Business Name): VHS ACQUISITION SUBSIDIARY NUMBER 4 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WILLIAM ST 2ND FLOOR
RIVER FOREST IL
60305-1920
US

IV. Provider business mailing address

20 BURTON HILLS BLVD STE 100 ATTENTION: CAROL BAILEY
NASHVILLE TN
37215-6409
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-4727
  • Fax: 708-763-2781
Mailing address:
  • Phone: 615-665-6000
  • Fax: 615-665-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL A BAILEY
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-665-6000