MEDICARE: MOUNT SINAI HOSPITAL 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	273R00000X	Psychiatric Hospital Unit	5229	IL

General Provider Information

NPI Number	:	1518057769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI HOSPITAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2750 W 15TH PLACE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	773-257-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0020
Country	:	US
Telephone Number	:	773-257-2000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. CHUCK WEIS
Credential	:
Telephone Number	:	773-257-6642

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/19/2008

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