Basic Information
| Provider Information | |||||||||
| NPI: | 1053698498 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESURRECTION HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RMC PROFESSIONAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 979 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604620979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086758160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7435 W TALCOTT AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735947875 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 04/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHORT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7737928673 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.