Provider Demographics
NPI:1598286510
Name:S & T MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:S & T MEDICAL GROUP LTD
Other - Org Name:S&T MEDICAL GROUP LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-563-6400
Mailing Address - Street 1:136 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4914
Mailing Address - Country:US
Mailing Address - Phone:773-563-6400
Mailing Address - Fax:630-454-3444
Practice Address - Street 1:136 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-4914
Practice Address - Country:US
Practice Address - Phone:773-563-6400
Practice Address - Fax:630-454-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045378Medicaid