Organization
LOYOLA UNIVERSITY MEDICAL CENTER
Active
Organization
LOYOLA UNIVERSITY MEDICAL CENTER
Active
Other names
Loyola University Home Infusion
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN P. MORDACH (CHIEF FINANCIAL OFFICER)
(708) 216-4252
Entity
Organization
Contact information
Practice address
9608 S ROBERTS RD, HICKORY HILLS, IL 60457-2238
(708) 216-3510
Mailing address
9608 S ROBERTS RD, HICKORY HILLS, IL 60457-2238
(708) 216-3510
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
0004630
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500
BLUE CROSS
IL
01
—
1671580
BLUE CROSS FEDERA
IL
01
—
9729
BLUE CROSS INFUSION
IL
Enumeration date
01/16/2007
Last updated
03/19/2010
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