MEDICARE: TINLEY ORLAND MEDICAL CENTER LLC

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	246X00000X	Cardiovascular Specialist/Technologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC0037	OTHER	IL	RAILROAD MEDICARE GRP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01634400	OTHER	IL	BCBS GROUP

General Provider Information

NPI Number	:	1619903119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINLEY ORLAND MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	18210 LA GRANGE RD
Second Line	:	SUITE 210
City	:	TINLEY PARK
State	:	IL
Zip	:	60487
Country	:	US
Telephone Number	:	708-342-7950
Fax Number	:	708-342-7962

Provider Business Practice Location Address
First Line	:	18210 LA GRANGE RD
Second Line	:	SUITE 210
City	:	TINLEY PARK
State	:	IL
Zip	:	60487
Country	:	US
Telephone Number	:	708-342-7950
Fax Number	:	708-342-7962

Authorized Official
Title or Position	:	VP AMBULATORY SERVICES
Name	:	DOMINICA TALLARICO
Credential	:
Telephone Number	:	708-684-5014

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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Directions to “TINLEY ORLAND MEDICAL CENTER LLC ” Practice Location

Language	Start Address	Practice Location

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