Provider Demographics
NPI:1013212356
Name:EDWARD HINES JR. VA HOSPITAL
Entity Type:Organization
Organization Name:EDWARD HINES JR. VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-202-7845
Mailing Address - Street 1:5800 W. 105TH STREET
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:773-339-8253
Mailing Address - Fax:708-221-7171
Practice Address - Street 1:5800 W 105TH ST
Practice Address - Street 2:UNIT 2A
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4385
Practice Address - Country:US
Practice Address - Phone:773-339-8253
Practice Address - Fax:708-221-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049131898286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital