Provider Demographics
NPI:1376641191
Name:HINES VA HOSPITAL
Entity Type:Organization
Organization Name:HINES VA HOSPITAL
Other - Org Name:HINES VA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRET
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:EISIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-202-8387
Mailing Address - Street 1:13824 S PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7076
Mailing Address - Country:US
Mailing Address - Phone:815-293-0027
Mailing Address - Fax:
Practice Address - Street 1:13824 S PETERSBURG DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7076
Practice Address - Country:US
Practice Address - Phone:815-293-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital