Provider Demographics
NPI:1356825483
Name:ST. ALEXIUS MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. ALEXIUS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKNISKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-312-7270
Mailing Address - Street 1:1555 BARRINGTON RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1099
Mailing Address - Country:US
Mailing Address - Phone:847-843-2000
Mailing Address - Fax:
Practice Address - Street 1:1555 BARRINGTON RD BLDG 1
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1099
Practice Address - Country:US
Practice Address - Phone:847-843-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. ALEXIUS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy