Provider Demographics
NPI:1407889652
Name:ADVENTIST MIDWEST HEALTH
Entity Type:Organization
Organization Name:ADVENTIST MIDWEST HEALTH
Other - Org Name:UCHICAGO MEDICINE ADVENTHEALTH LA GRANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HARMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-856-6001
Mailing Address - Street 1:5101 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2600
Mailing Address - Country:US
Mailing Address - Phone:708-352-1200
Mailing Address - Fax:630-312-7975
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-352-1200
Practice Address - Fax:630-312-7975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTIST MIDWEST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0005017282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364257550001Medicaid
IL140065OtherSTERLING PLAN
IL140065OtherUNICARE
IL364257550001OtherCHAMPUS
IL399OtherBLUE CROSS
IL364257550001Medicaid