Organization
ST JAMES HOSPITAL AND HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA BASS (ACCOUNT REPRESENTATIVE)
(708) 755-3348
Entity
Organization
Contact information
Practice address
30 E 15TH ST, CHICAGO HEIGHTS, IL 60411-3459
(708) 709-2010
Mailing address
30 E 15TH ST STE 406, CHICAGO HEIGHTS, IL 60411-3459
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619159
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/28/2006
Last updated
08/22/2020
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