Provider Demographics
NPI:1598756686
Name:INGALLS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:INGALLS MEMORIAL HOSPITAL
Other - Org Name:THE INGALLS MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:NEISWONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-915-6111
Mailing Address - Street 1:150 HARVESTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5965
Mailing Address - Country:US
Mailing Address - Phone:708-915-6107
Mailing Address - Fax:708-915-2099
Practice Address - Street 1:1 INGALLS DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3558
Practice Address - Country:US
Practice Address - Phone:708-915-6107
Practice Address - Fax:708-915-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0001099273R00000X, 273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL025OtherBLUE CROSS PROVIDER NUMBE
IL140191Medicare Oscar/Certification