Organization
COOK COUNTY
Active
Parent organization
COOK COUNTY
Other names
Provident Hospital of Cook County
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOK COUNTY
Authorized official
MR. SCOTT ANDRLE (DIRECTOR OF MANAGED CARE OPERATIONS)
(312) 864-4649
Entity
Organization
Contact information
Practice address
500 EAST 51ST STREET, CHICAGO, IL 60615-2494
(312) 572-1200
(312) 572-1294
Mailing address
500 EAST 51ST STREET, CHICAGO, IL 60615-2494
(312) 572-1200
(312) 572-1294
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
0004549
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/09/2006
Last updated
05/13/2025
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