Organization
PALOS COMMUNITY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL V VIVODA (PRESIDENT)
(708) 923-5000
Entity
Organization
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1256
(708) 361-4500
(708) 923-4000
Mailing address
12251 S 80TH AVE STE 1630, PALOS HEIGHTS, IL 60463-1290
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
—
—
282N00000X
General Acute Care Hospital
Primary
0003210
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16020
—
IL
01
—
52
BLUE CROSS NUMBER
IL
Enumeration date
09/19/2005
Last updated
04/16/2026
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