Basic Information
| Provider Information | |||||||||
| NPI: | 1376025304 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LORETTO HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LORETTO HOSPITAL AT SYMPHONY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 645 S CENTRAL AVE | ||||||||
| Address2: | BUSINESS OFFICE | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738545066 | ||||||||
| FaxNumber: | 7736267902 | ||||||||
| Practice Location | |||||||||
| Address1: | 5130 W JACKSON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606444332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736264300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 09/06/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 7738545066 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.