Basic Information
| Provider Information | |||||||||
| NPI: | 1831420520 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVOCATE HEALTH AND HOSPITALS CORP. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVOCATE BROMENN REGIONAL MEDICAL CENTER BH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2311 W 22ND ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303201090 | ||||||||
| FaxNumber: | 6303201231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617613558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094541400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | VOSS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6303201090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.