Provider Demographics
NPI:1194386706
Name:MOUNT SINAI HOSPITAL, CHICAGO
Entity Type:Organization
Organization Name:MOUNT SINAI HOSPITAL, CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-257-5914
Mailing Address - Street 1:903 S ASHLAND AVE APT. 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:415-323-9159
Mailing Address - Fax:
Practice Address - Street 1:MOUNT SINAI HOSPITAL, 1500 S FAIRFIELD AVE ,
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:415-323-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty