Organization
ADVENTIST MIDWEST HEALTH
Active
Organization
ADVENTIST MIDWEST HEALTH
Active
Other names
LAGRANGE MEMORIAL HOSPITAL CARDIOLOLGY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUBY MANN (DIRECTOR OF MANAGED CARE)
(630) 856-6884
Entity
Organization
Contact information
Practice address
5101 WILLOW SPRINGS RD, LA GRANGE, IL 60525-2600
(708) 245-3650
Mailing address
5101 WILLOW SPRINGS RD, LA GRANGE, IL 60525-2600
(708) 245-3650
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG5784
RAILROAD MEDICARE PTAN
IL
Enumeration date
12/04/2006
Last updated
04/21/2016
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