Organization
ALVERNO LAKESIDE CORPORATION
Active
Parent organization
ST. JAMES HOSPITAL, UNITED STATES CATHOLIC CONFERENCE
Other names
Alverno Advanced Life Support Service
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. JAMES HOSPITAL, UNITED STATES CATHOLIC CONFERENCE
Authorized official
MR. JOHN SLYKAS (MANAGER)
(708) 747-4000
Entity
Organization
Contact information
Practice address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461-1010
(708) 756-1200
(708) 481-5583
Mailing address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461-1010
(708) 747-4000
(708) 755-3392
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
77967
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1626513
BCBS PROVIDER NUMBER
IL
01
—
590014070
MEDICARE RAILROAD
IL
Enumeration date
05/23/2005
Last updated
01/10/2011
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