Provider Demographics
NPI:1518266345
Name:ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Entity Type:Organization
Organization Name:ST JAMES HOSPITAL UNITED STATES CATHOLIC CONFERENCE
Other - Org Name:ST JAMES PRIMARY CARE CENTER OF MOKENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:SENESAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-756-1000
Mailing Address - Street 1:1423 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3400
Mailing Address - Country:US
Mailing Address - Phone:708-756-1000
Mailing Address - Fax:
Practice Address - Street 1:19807 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8348
Practice Address - Country:US
Practice Address - Phone:708-679-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty