Provider Demographics
NPI:1457629966
Name:ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Entity Type:Organization
Organization Name:ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Other - Org Name:FRANCISCAN ST JAMES FAMILY HEALTH CENTER OF CHICAGO HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SENESAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-756-1000
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4250
Mailing Address - Fax:317-865-8316
Practice Address - Street 1:30 E 15TH ST
Practice Address - Street 2:SUITE # 308
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-755-9355
Practice Address - Fax:708-755-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty