Provider Demographics
NPI:1518170877
Name:SAINT ANTHONY HOSPITAL
Entity Type:Organization
Organization Name:SAINT ANTHONY HOSPITAL
Other - Org Name:PSYCHIATRIC DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEDAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-484-1000
Mailing Address - Street 1:2875 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3501
Mailing Address - Country:US
Mailing Address - Phone:773-484-1000
Mailing Address - Fax:
Practice Address - Street 1:2875 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:773-484-4800
Practice Address - Fax:773-484-4806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT ANTHONY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004556273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210OtherBCBS
IL5276091OtherAETNA
IL5276091OtherAETNA
IL=========009Medicaid
IL5276091OtherAETNA