Basic Information
| Provider Information | |||||||||
| NPI: | 1679627376 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAINTS MARY AND ELIZABETH MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | SAINT ELIZABETH HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1431 N CLAREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606221702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732782000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1127 N OAKLEY BLVD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606223507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735728500 | ||||||||
| FaxNumber: | 7735728568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PFISTER | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SYSTEM DIRECTOR, PFS | ||||||||
| AuthorizedOfficialTelephone: | 7737929903 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0049 | 01 | IL | BX IL PROVIDER NUMBER | OTHER |