Provider Demographics
NPI:1295010056
Name:SAINT ANTHONY HEALTH AFFILIATES
Entity Type:Organization
Organization Name:SAINT ANTHONY HEALTH AFFILIATES
Other - Org Name:THE PHYSICIAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-484-1000
Mailing Address - Street 1:2001 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2486
Mailing Address - Country:US
Mailing Address - Phone:773-484-4783
Mailing Address - Fax:
Practice Address - Street 1:2875 WEST 19TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:773-484-4425
Practice Address - Fax:773-521-0223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ANTHONY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-12
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN