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General NPI Number Information
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NPI Number | 1366670580
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Entity Type | Organization
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Legal Business Name | JOHN H STROGER HOSPITAL OF COOK COUNTY
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCAS ST SUITE 812-CSB
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 312-375-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 ASHLEY TOWN CENTER DR 447
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City | CHARLESTON
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State | SC
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Zip | 29414-5682
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Country | US
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Telephone | 312-375-3257
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DR. SUJA MATHEW
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Credential | M.D.
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Telephone | 312-864-7218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 125051665
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License Number State | IL
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