Provider Demographics
NPI:1033318712
Name:RESURRECTION HEALTH CARE PREFERRED
Entity Type:Organization
Organization Name:RESURRECTION HEALTH CARE PREFERRED
Other - Org Name:SAINT JOSEPH HEALTH PREFERRED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR, PHYSICIAN MGD CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:STACKPOLE
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-572-8331
Mailing Address - Street 1:1021 W ADAMS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2934
Mailing Address - Country:US
Mailing Address - Phone:773-572-8300
Mailing Address - Fax:312-455-9485
Practice Address - Street 1:1021 W ADAMS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2934
Practice Address - Country:US
Practice Address - Phone:773-572-8300
Practice Address - Fax:312-455-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization