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NPI Code Detail

MEDICARE: JESSE BROWN VETERANS ADMINISTRATION HOSPITAL

MEDICARE: JESSE BROWN VETERANS ADMINISTRATION HOSPITAL
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
1282NC0060XCritical Access Hospital036066117IL

General Provider Information

NPI Number : 1679561260
Entity Type Code : Organization
Provider Name (Legal Business Name) : JESSE BROWN VETERANS ADMINISTRATION HOSPITAL
Provider Business Mailing Address
First Line : 950 N CLARK ST
Second Line : UNIT K.,
City : CHICAGO
State : IL
Zip : 60610-8701
Country : US
Telephone Number : 312-280-1840
Fax Number : 312-280-4546
Provider Business Practice Location Address
First Line : 820 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3728
Country : US
Telephone Number : 312-569-6123
Fax Number : 312-569-8102
Authorized Official
Title or Position : STAFF RADIOLOGIST
Name : DR. FARIDA AHMED
Credential : M.D.
Telephone Number : 312-569-6123
Provider Enumeration Date : 10/09/2005
Last Update Date : 07/21/2008

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Directions to “JESSE BROWN VETERANS ADMINISTRATION HOSPITAL ” Practice Location

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