MEDICARE: VHS ACQUISITION SUBSIDIARY NUMBER 3 INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	208800000X	Urology Physician
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1632681	OTHER	IL	BCBS - IL

General Provider Information

NPI Number	:	1922060938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VHS ACQUISITION SUBSIDIARY NUMBER 3 INC

Provider Business Mailing Address
First Line	:	20 BURTON HILLS BLVD
Second Line	:	SUITE 100, ATTENTION, CAROL BAILEY
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6197
Country	:	US
Telephone Number	:	615-665-6000
Fax Number	:	615-665-6184

Provider Business Practice Location Address
First Line	:	4646 N MARINE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5759
Country	:	US
Telephone Number	:	773-564-5102
Fax Number	:	773-564-5101

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CAROL A BAILEY
Credential	:
Telephone Number	:	615-665-6000

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	09/08/2016

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