MEDICARE: MOUNT SINAI MEDICAL CENTER

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255288254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1501 S CALIFORNIA AVE # 7-140
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1732
Country	:	US
Telephone Number	:	773-257-2933
Fax Number	:	773-762-8834

Provider Business Practice Location Address
First Line	:	2653 W OGDEN AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1647
Country	:	US
Telephone Number	:	773-257-6672
Fax Number	:	773-257-5330

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	CHRISTOPHER STEPHENS
Credential	:
Telephone Number	:	773-257-2933

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “MOUNT SINAI MEDICAL CENTER ” Practice Location

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