Provider Demographics
NPI:1558517896
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 HOSPITAL AND HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDA
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:708-755-3392
Practice Address - Street 1:19110 DAVIN DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-756-1000
Practice Address - Fax:708-755-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1744997282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL140172OtherMEDICARE PROVIDER NUMBER