Healthcare Provider Details

I. General information

NPI: 1902074784
Provider Name (Legal Business Name): LOUIS A WEISS MEMORAIL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 DANBURY DR UNITB-2
WOODRIDGE IL
60517-2091
US

IV. Provider business mailing address

2400 DANBURY DR UINT-2
WOODRIDGE IL
60517-2091
US

V. Phone/Fax

Practice location:
  • Phone: 630-395-9105
  • Fax: 630-395-9105
Mailing address:
  • Phone: 630-395-9105
  • Fax: 630-395-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. NAKKA VENKAT ARUNA KUMARI
Title or Position: CERIFIED SURGICAL ASSISTANTS
Credential: MBBS9(OSM)
Phone: 630-395-9105