Basic Information
| Provider Information | |||||||||
| NPI: | 1235680299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST BERNARD HOSPITAL OB/GYN GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 326 W 64TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606213114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739623900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 W 64TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606213114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739623900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7739624100 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST BERNARD HOSPITAL AND HEALTH CARE CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.