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General NPI Number Information
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NPI Number | 1750484721
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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 | 09/06/2006
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-0469
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-0469
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | LARRY M GOLDBERG
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Credential |
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Telephone | 708-216-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 0004630
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License Number State | IL
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