MEDICARE: SOUTH SHORE HOSPITAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	1706462	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053391359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHORE HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	8012 S CRANDON AVE
Second Line	:	FINANCE DEPARTMENT
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5312
Fax Number	:	773-768-8154

Provider Business Practice Location Address
First Line	:	8012 S CRANDON AVE
Second Line	:	FINANCE DEPARTMENT
City	:	CHICAGO
State	:	IL
Zip	:	60617-1124
Country	:	US
Telephone Number	:	773-356-5312
Fax Number	:	773-768-8154

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. TIMOTHY ARTHUR CAVENEY
Credential	:
Telephone Number	:	773-356-5312

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/22/2020

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Directions to “SOUTH SHORE HOSPITAL CORPORATION ” Practice Location

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