Provider Demographics
NPI:1336299544
Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Entity Type:Organization
Organization Name:PRESENCE CENTRAL AND SUBURBAN HOSPITALS NETWORK
Other - Org Name:PRESENCE ST. MARY HOSPITAL RDU (RENAL DIALYSIS UNIT)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-308-3981
Mailing Address - Street 1:500 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3661
Mailing Address - Country:US
Mailing Address - Phone:815-937-2470
Mailing Address - Fax:815-937-8743
Practice Address - Street 1:500 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3661
Practice Address - Country:US
Practice Address - Phone:815-937-2470
Practice Address - Fax:815-937-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
142318Medicare UPIN