Provider Demographics
NPI:1487825089
Name:ALSIP MEDICAL CENTER
Entity Type:Organization
Organization Name:ALSIP MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CETERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-489-6200
Mailing Address - Street 1:11808 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1608
Mailing Address - Country:US
Mailing Address - Phone:708-489-6200
Mailing Address - Fax:
Practice Address - Street 1:11808 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1608
Practice Address - Country:US
Practice Address - Phone:708-489-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-22
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty