MEDICARE: LOYOLA UNIVERSITY HOSPITAL SYSTEM

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	125057873	IL

General Provider Information

NPI Number	:	1447571013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYOLA UNIVERSITY HOSPITAL SYSTEM

Provider Business Mailing Address
First Line	:	1041 SUSAN COLLINS LN APT 501
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-5412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 SUSAN COLLINS LN APT 501
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-5412
Country	:	US
Telephone Number	:	585-506-5749
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF INT MEDICINE RESIDENCY
Name	:	DR. KEVIN SIMPSON
Credential	:
Telephone Number	:	708-216-6497

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/18/2010

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