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General NPI Number Information
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NPI Number | 1629220546
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Entity Type | Organization
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Legal Business Name | VA HOSPITAL
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 847-688-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W RAVINE AVE
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1455
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Country | US
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Telephone | 312-206-6000
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Fax |
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Authorized Official
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Title or Position | NUCLEAR MEDICINE TECHNOLOGIST
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Name | MR. JOHN M SIEJA
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Credential | CNMT
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Telephone | 312-206-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 032417
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License Number State | IL
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