# ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST JAMES DIABETES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073794517
- **Authorized official:** MRS. DEANNA MARIE BASS (BILLER)
- **Authorized official phone:** (708) 755-3348

## Contact information

- **Practice address:** 30 E 15TH ST, SUITE 314, CHICAGO HEIGHTS, IL 60411-3459
- **Practice address phone:** (708) 709-2010
- **Practice address fax:** (708) 755-3393
- **Mailing address:** 30 E 15TH ST, SUITE 314, CHICAGO HEIGHTS, IL 60411-3459
- **Mailing address phone:** (708) 709-2010
- **Mailing address fax:** (708) 755-3393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 1813312 | IL | Yes |

## Other

- **Enumeration date:** 11/26/2007
- **Last updated:** 09/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036046124 | — | IL |
| 01 | — | 1619159 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | CC1471 | RAILROAD | IL |