MEDICARE: CENTER FOR DIGESTIVE HEALTH

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	261QA1903X	Ambulatory Surgical Clinic/Center	7002876	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50356	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1619920501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR DIGESTIVE HEALTH

Provider Business Mailing Address
First Line	:	1615 N CONVENT ST
Second Line	:
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914-1092
Country	:	US
Telephone Number	:	815-936-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 N CONVENT ST
Second Line	:
City	:	BOURBONNAIS
State	:	IL
Zip	:	60914-1092
Country	:	US
Telephone Number	:	815-936-1700
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CHRISTINA O'CONNOR
Credential	:
Telephone Number	:	815-937-5200

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	09/05/2024

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Directions to “CENTER FOR DIGESTIVE HEALTH ” Practice Location

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