Organization
LITTLE COMPANY OF MARY HOSPITAL INC
Active
Other names
LCMH MOBILE MEDICAL PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
MARY FREYER (CHIEF OPERATING OFFICER)
(708) 229-5004
Entity
Organization
Contact information
Practice address
9800 SOUTHWEST HWY, OAK LAWN, IL 60453-3617
(708) 229-4663
(708) 499-5975
Mailing address
9800 SOUTHWEST HWY, OAK LAWN, IL 60453-3617
(708) 229-4663
(708) 499-5975
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0161859661
BCBS OF IL
IL
01
—
CC0511
RR MEDICARE
IL
Enumeration date
02/14/2007
Last updated
03/16/2010
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