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General NPI Number Information
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NPI Number | 1598175507
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Entity Type | Organization
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Legal Business Name | LOYOLA UNIVERSITY MEDICAL CENTER
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 6800 N FRONTAGE RD
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City | BURR RIDGE
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State | IL
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Zip | 60527-7819
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Country | US
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Telephone | 708-327-1004
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Fax | 708-327-1003
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Provider Business Mailing Address
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Address Line | 2160 S. FIRST AVENUE
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City | MAYWOOD
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State | IL
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Zip | 60153-3304
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Country | US
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Telephone | 708-216-8686
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Fax | 708-216-8059
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Authorized Official
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Title or Position | CFO
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Name | MR. AJAY S. SIAL
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Credential |
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Telephone | 708-216-4252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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