Provider Demographics
NPI:1053665786
Name:TEAMHEALTH PROVENA MERCY HOSPITAL
Entity Type:Organization
Organization Name:TEAMHEALTH PROVENA MERCY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-785-9100
Mailing Address - Street 1:1 TRANSAM PLAZA DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4822
Mailing Address - Country:US
Mailing Address - Phone:630-785-9100
Mailing Address - Fax:630-785-9199
Practice Address - Street 1:1325 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1449
Practice Address - Country:US
Practice Address - Phone:630-859-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004497282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital