Organization
ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Active
Other names
ST JAMES DIABETES
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEANNA MARIE BASS (BILLER)
(708) 755-3348
Entity
Organization
Contact information
Practice address
30 E 15TH ST, SUITE 314, CHICAGO HEIGHTS, IL 60411-3459
(708) 709-2010
(708) 755-3393
Mailing address
30 E 15TH ST, SUITE 314, CHICAGO HEIGHTS, IL 60411-3459
(708) 709-2010
(708) 755-3393
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
1813312
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036046124
—
IL
01
—
1619159
BLUE CROSS BLUE SHIELD
IL
01
—
CC1471
RAILROAD
IL
Enumeration date
11/26/2007
Last updated
09/15/2008
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