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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