Organization
PRESENCE HOSPITALS PRV
Active
Parent organization
PRESENCE HOSPITALS - PRV
Other names
Presence St. Mary's Cancer Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRESENCE HOSPITALS - PRV
Authorized official
ANTHONY J. FILER (SYSTEM, CHIEF FINANCIAL OFFICER)
(708) 478-7674
Entity
Organization
Contact information
Practice address
100 PROVENA WAY, SUITE 103, BOURBONNAIS, IL 60914-4796
(815) 937-8780
(815) 937-8241
Mailing address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2490
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0004879
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004621885
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/09/2007
Last updated
01/22/2013
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