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General NPI Number Information
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NPI Number | 1750678934
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI HOSPITAL MEDICAL CENTER
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 812 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-4140
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Country | US
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Telephone | 312-666-6897
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Fax |
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Provider Business Mailing Address
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Address Line | 812 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-4140
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Country | US
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Telephone | 312-666-6897
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT/COO
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Name | KAREN C TEITELBAUM
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Credential |
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Telephone | 773-257-5332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 0001644
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License Number State | IL
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