Provider Demographics
NPI:1235680299
Name:ST BERNARD HOSPITAL OB/GYN GROUP
Entity Type:Organization
Organization Name:ST BERNARD HOSPITAL OB/GYN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-962-4100
Mailing Address - Street 1:326 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-3114
Mailing Address - Country:US
Mailing Address - Phone:773-962-3900
Mailing Address - Fax:
Practice Address - Street 1:326 W 64TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3114
Practice Address - Country:US
Practice Address - Phone:773-962-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST BERNARD HOSPITAL AND HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty