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General NPI Number Information
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NPI Number | 1073794517
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Entity Type | Organization
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Legal Business Name | ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 30 E 15TH ST SUITE 314
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3459
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Country | US
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Telephone | 708-709-2010
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Fax | 708-755-3393
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Provider Business Mailing Address
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Address Line | 30 E 15TH ST SUITE 314
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3459
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Country | US
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Telephone | 708-709-2010
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Fax | 708-755-3393
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Authorized Official
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Title or Position | BILLER
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Name | MRS. DEANNA MARIE BASS
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Credential |
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Telephone | 708-755-3348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1813312
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License Number State | IL
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