Organization
LOYOLA UNIVERSITY MEDICAL CENTER
Active
Other names
Loyola University Air Ambulance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN P MORDACH (CFO)
(708) 216-4252
Entity
Organization
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-0469
(708) 216-0593
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-0469
(708) 216-0593
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
Primary
8 825001
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500
BLUE CROSS
IL
05
—
364015560004
—
IL
Enumeration date
01/23/2007
Last updated
01/07/2010
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