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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	0001644	IL

General Provider Information

NPI Number	:	1639470867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI HOSPITAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1500 S FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 W 21ST PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-4010
Country	:	US
Telephone Number	:	773-890-7676
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	ALAN H. CHANNING
Credential	:
Telephone Number	:	773-542-2000

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	09/12/2011

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