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General NPI Number Information
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NPI Number | 1013440361
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Entity Type | Organization
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Legal Business Name | EDWARD HINES JR. VA HOSPITAL
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 5000 S 5TH AVE
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-202-8387
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Fax | 708-202-2252
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Provider Business Mailing Address
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Address Line | 5000 S 5TH AVE
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City | HINES
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State | IL
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Zip | 60141-3030
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Country | US
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Telephone | 708-202-8387
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Fax | 708-202-2252
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Authorized Official
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Title or Position | NUTRITION SUPPORT DIETITIAN
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Name | MS. TERESA A UEMURA
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Credential | RD LDN CNSC
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Telephone | 708-203-7576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 164.003239
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License Number State | IL
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