MEDICARE: JESSE BROWN VA MEDICAL CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	2865M2000X	Military General Acute Care Hospital	IL
2	2865M2000X	Military General Acute Care Hospital	WI
3	2865M2000X	Military General Acute Care Hospital	IL

General Provider Information

NPI Number	:	1497716922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSE BROWN VA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1244 BEVERLY DR
Second Line	:
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-6408
Country	:	US
Telephone Number	:	847-265-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3728
Country	:	US
Telephone Number	:	312-569-8387
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE OFFICER, ANESTHESIOL
Name	:	MISS RHETTA TURNER
Credential	:
Telephone Number	:	312-569-8387

Provider Enumeration Date	:	04/02/2006
Last Update Date	:	08/22/2020

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