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NPI Code Detail

MEDICARE: LITTLE COMPANY OF MARY HOSPITAL INC

MEDICARE: LITTLE COMPANY OF MARY HOSPITAL INC
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
1282N00000XGeneral Acute Care Hospital1744976IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1030OTHERILBLUE CROSS

General Provider Information

NPI Number : 1598768780
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE COMPANY OF MARY HOSPITAL INC
Provider Business Mailing Address
First Line : 2800 W 95TH ST
Second Line :
City : EVERGREEN PARK
State : IL
Zip : 60805-2746
Country : US
Telephone Number : 708-422-6200
Fax Number : 708-499-8510
Provider Business Practice Location Address
First Line : 2800 W 95TH ST
Second Line :
City : EVERGREEN PARK
State : IL
Zip : 60805-2746
Country : US
Telephone Number : 708-422-6200
Fax Number : 708-499-8510
Authorized Official
Title or Position : MANAGER BUSINESS OFFICE
Name : MRS. CANDACE ANN BAKER
Credential :
Telephone Number : 708-229-5126
Provider Enumeration Date : 05/23/2005
Last Update Date : 03/22/2010

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Directions to “LITTLE COMPANY OF MARY HOSPITAL INC ” Practice Location

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