Organization
ST JAMES HOSPITAL AND CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN WAGNER D.O. (RESIDENT)
(920) 585-2839
Entity
Organization
Contact information
Practice address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461-1010
(708) 747-4000
Mailing address
474 N LAKE SHORE DR, APT. 4106, CHICAGO, IL 60611-3400
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
125.064852
IL
Other
Enumeration date
07/07/2014
Last updated
10/14/2015
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