Provider Demographics
NPI:1275815300
Name:ST JOSEPH HOSPITAL
Entity Type:Organization
Organization Name:ST JOSEPH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-318-8702
Mailing Address - Street 1:2756 N PINE GROVE AVE
Mailing Address - Street 2:UNIT 308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-857-5107
Mailing Address - Fax:
Practice Address - Street 1:2756 N PINE GROVE AVE
Practice Address - Street 2:UNIT 308
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6138
Practice Address - Country:US
Practice Address - Phone:773-857-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:363200170
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059045282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital