Provider Demographics
NPI:1356468409
Name:SILVER CROSS HOSPITAL AND MEDICAL CENTERS
Entity Type:Organization
Organization Name:SILVER CROSS HOSPITAL AND MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-300-7139
Mailing Address - Street 1:1900 SILVER CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9509
Mailing Address - Country:US
Mailing Address - Phone:815-300-7139
Mailing Address - Fax:815-300-4954
Practice Address - Street 1:1551 CREEK DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-6857
Practice Address - Country:US
Practice Address - Phone:815-740-7139
Practice Address - Fax:815-740-4954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER CROSS HOSPITAL AND MEDICAL CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1706432261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========006Medicaid
IL=========006Medicaid