Provider Demographics
NPI:1275863904
Name:WEISS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WEISS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN M.D.
Authorized Official - Prefix:MS
Authorized Official - First Name:BUSHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-961-8194
Mailing Address - Street 1:4600 N CLARENDON AVE
Mailing Address - Street 2:THE COVINGTON
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5710
Mailing Address - Country:US
Mailing Address - Phone:773-961-8194
Mailing Address - Fax:
Practice Address - Street 1:4600 N CLARENDON AVE
Practice Address - Street 2:THE COVINGTON
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5710
Practice Address - Country:US
Practice Address - Phone:773-961-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access