Basic Information
| Provider Information | |||||||||
| NPI: | 1487916169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT MARYS AND ELIZABETH MEDICAL CENTRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 W DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606228151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127702000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2233 W DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606228151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127702000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 06/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | AZIZ | ||||||||
| AuthorizedOfficialFirstName: | ARSHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CRISIS WORKER | ||||||||
| AuthorizedOfficialTelephone: | 3127702000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.B.B.S | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.