Provider Demographics
NPI:1609079557
Name:ST. JOSEPH HOSPITAL
Entity Type:Organization
Organization Name:ST. JOSEPH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:LWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-864-0001
Mailing Address - Street 1:2624 HIGH MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4322
Mailing Address - Country:US
Mailing Address - Phone:630-864-0001
Mailing Address - Fax:
Practice Address - Street 1:2900 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5640
Practice Address - Country:US
Practice Address - Phone:773-665-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050612282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital